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Most patients with Hodgkin lymphoma, even in advanced stages, can be treated successfully. However, treatment may cause late side effects, and sometimes the disease returns.
Lymphoma is a general term for cancers that develop in the lymph system, which is part of the body’s immune system. Hodgkin lymphoma is a type of lymphoma that develops in the white blood cells. Almost all Hodgkin lymphoma cases contain Reed-Sternberg cells, a specific type of large cancer cell that is not found in non-Hodgkin lymphomas. While Hodgkin lymphoma can start in the lymph nodes, it can spread to almost any organ or tissue, including the liver, bone marrow and spleen.
Hodgkin Lymphoma Types
Hodgkin lymphoma is divided into two major types according to how the lymph cells look under a microscope and whether Reed-Sternberg cells are present. Knowing the type of lymphoma helps doctors determine your best treatment.
Classical Hodgkin Lymphoma is the most common type in the United States. It accounts for about 95% of cases and is the most curable Hodgkin lymphoma. Subtypes include:
- Nodular Sclerosing Hodgkin Lymphoma: The affected lymph nodes have mixed areas of normal cells, Reed-Sternberg cells and prominent scar tissue. This is the most common type, making up 60% to 80% of cases. It is more common in adolescents and young adults, but it can occur at any age.
- Lymphocyte-Rich Hodgkin Lymphoma: This recently created subtype in the past was confused sometimes with lymphocyte-predominant lymphoma. It is similar to mixed cellularity Hodgkin lymphoma.
- Mixed Cellularity Hodgkin Lymphoma: The affected lymph nodes contain many Reed-Sternberg cells in addition to several other cell types. Mixed cellularity accounts for about 25% to 30% of cases of Hodgkin lymphoma. It primarily affects older adults.
- Lymphocyte Depletion Hodgkin Lymphoma: Large numbers of Reed-Sternberg cells, but very few other cell types, are found in the lymph nodes. This is the least common form of Hodgkin lymphoma, and it is seen more often in people who are elderly or have AIDS.
Nodular Lymphocyte-Predominant Hodgkin Lymphoma: This rare disease accounts for just 5% of Hodgkin lymphoma diagnoses and is most common among men between 35 and 40. Unlike other types of Hodgkin lymphoma, it produces no Reed-Sternberg cells. It is usually diagnosed at an early stage and has an excellent survival rate.
Hodgkin Lymphoma Risk Factors
Anything that increases your chance of getting Hodgkin lymphoma is a risk factor. Although Hodgkin lymphoma usually develops in people who have no risk factors, the following things may mean you are more likely to develop it:
- Age: Hodgkin lymphoma is most common in young adults (15 to 40 years) and older adults (over 55 years old).
- Gender: Males are slightly more likely to develop Hodgkin lymphoma.
- Viruses: The risk is small, but some viruses may make you more likely to get Hodgkin lymphoma. These include:
- Epstein-Barr virus (EBV)
- Infectious mononucleosis (mono)
- Human immunodeficiency virus (HIV)
- Human T-cell lymphocytotropic virus (HTLV)
- Family history: If you have a parent, brother or sister with Hodgkin lymphoma, you have an increased risk of developing the disease.
Not everyone with risk factors gets Hodgkin lymphoma. However, if you have risk factors, you should discuss them with your doctor.
Learn more about Hodgkin lymphoma:
Why choose MD Anderson for your Hodgkin lymphoma treatment?
Our team of experts is one of the few focused only on lymphoma. While most oncologists see only one or two Hodgkin lymphoma patients a year, we treat hundreds annually, giving us a remarkable depth of experience and expertise.
At MD Anderson, you are cared for by a team of some of the nation's top authorities on lymphoma. They draw upon the latest and
Innovative, Advanced Options
As one of the world's leaders in lymphoma advances, we constantly work to pioneer new treatments that are effective and have the least impact on your body. For instance, MD Anderson has helped advance the development of several new targeted therapies for Hodgkin lymphoma. And we are studying several biomarkers to guide the future development of even more personalized therapies.
Whether you recently have been diagnosed with Hodgkin lymphoma or have battled the disease for years, we can help.
Become an expert on your disease. Be able to verbalize it to your providers and don't take "no" for an answer when they tell you nothing's wrong. Keep going until you find someone who will listen.
In the summer of 2013, Debbie Felix-Dejean was facing her third round of Hodgkin lymphoma, and she was not optimistic.
The Caribbean expatriate had received her first Hodgkin lymphoma diagnosis in 2004, while living in South Africa. Her second diagnosis came in 2010, while Debbie was living in Florida. Three years later, she found a lump in her left armpit.
“Usually, Hodgkin lymphoma is considered the best type of cancer to have because it’s easy to treat and has a fantastic cure rate,” Debbie says. “But I had already been through this two times before, and I thought, ‘Well, maybe this is it.’”
Clinical trial offers new chemotherapy combination
Fearing a grim prognosis, Debbie waited a few months before seeking treatment. But at a friend’s insistence, she finally made an appointment at MD Anderson. Here, Debbie saw Jason Westin, M.D. He confirmed her self-diagnosis, but he also gave her hope.
Debbie learned that she was eligible for a Phase II clinical trial under Yago Nieto, M.D., Ph.D. The clinical trial involved a new combination of high-dose chemotherapy drugs (gemcitabine, busulfan and melphalan), in preparation for an autologous stem cell transplant.
“The drugs were not new, but the combination was,” she says. “So when I was given the option for a clinical trial, I took it.”
Debbie began the clinical trial in Sept. 2013. Her autologous stem cell transplant took place in Dec. 2013.
“Christmas Day was the last day of my infusion,” she says. “It was the best gift ever.”
Extraordinary complication delays stem cell transplant recovery
Debbie initially did so well after the stem cell transplant that she enrolled in a master’s degree program the following August. But a month into her studies, she started feeling sick again and had to drop out.
Bloodwork revealed that her platelet level was only at about 5,000 — far below the normal range of 150,000–300,000. Debbie began receiving transfusions, sometimes twice a day. Each one boosted her levels temporarily, but then they plummeted again.
“The doctors said my body was rejecting its own cells from the stem cell transplant, which was something they hadn’t seen before,” Debbie says. “Eventually, my platelet count got down to zero. I was bleeding in my mouth and had bruises all over my body, despite getting transfusions every day.”
Doctors performed a splenectomy to reverse that trend, but it didn’t work. They also tried a drug called aminocaproic acid, which caused temporary paralysis in Debbie’s legs. Finally, they recommended another stem cell transplant. Debbie resisted, but by this time she had been in the hospital for five months. She was also running out of options.
“Dr. Michael Kroll said, ‘Look. We cannot continue to support you like this. It’s just not sustainable,’” she says. “That was a hard pill to swallow, but I finally agreed.”
Preparing for a second stem cell transplant
The doctors pulled Debbie off of all her medications in preparation for the stem cell transplant. She reached out to her siblings and her older brother was identified as a good match. He began making arrangements to come to Houston. Meanwhile, her platelet levels began to improve.
But while her brother was trying to get a visa to come here, he was murdered. “Just the week before, he had called me from the Caribbean and said, ‘Don’t worry, Debbie. I’m going to take care of this. You’re going to be better,’” she recalls.
An unexpected remission
Debbie was devastated. She and her brother had been very close. And none of her other five siblings was a good match. But her platelet levels continued to climb, so she postponed the second transplant.
Eventually, Debbie’s platelet levels reached a critical milestone, and she was discharged from the hospital. Debbie never did have the second stem cell transplant. Instead, she slowly recovered and regained her strength. Today, she still has a little bit of neuropathy, but otherwise, she shows no evidence of disease.
“Some things you just can’t explain,” Debbie says. “My case was one in a billion. That rejection was not supposed to happen. But I received incredible care at MD Anderson. I don’t know that I would have survived if I had not come here. I feel very fortunate.”
Advice for other stem cell transplant candidates
Recently, Debbie signed up to volunteer through myCancerConnection, MD Anderson’s one-on-one support program for patients and caregivers.
The three-time Hodgkin lymphoma survivor already knows what she’ll say to patients facing a stem cell transplant.
“It’s going to be hard,” she says. “But, you are strong enough to go through it. The treatment doesn’t last forever. You will get better. And when you do, you will not even remember how hard it was. You will only remember that you had it, and you will be grateful. I am really happy that I made it. And to save my life, I would do it again.”
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B-Cell Lymphoma Moon Shot
MD Anderson’s B-Cell Lymphoma Moon Shot® aims to rapidly and dramatically improve treatment outcomes for Hodgkin lymphoma patients through powerful new treatment approaches and research.Learn more about the B-Cell Lymphoma Moon Shot