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Most patients with Hodgkin’s 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’s lymphoma is a type of lymphoma that develops in the white blood cells. Almost all Hodgkin’s lymphoma cases contain Reed-Sternberg cells, a specific type of large cancer cell that is not found in non-Hodgkin’s lymphomas. While Hodgkin’s lymphoma can start in the lymph nodes, it can spread to almost any organ or tissue, including the liver, bone marrow and spleen.
Hodgkin’s Lymphoma Types
Hodgkin’s 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’s Lymphoma is the most common type in the United States. It accounts for about 95% of cases and is the most curable Hodgkin’s lymphoma. Subtypes include:
- Nodular Sclerosing Hodgkin’s 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’s Lymphoma: This recently created subtype in the past was confused sometimes with lymphocyte-predominant lymphoma. It is similar to mixed cellularity Hodgkin’s lymphoma.
- Mixed Cellularity Hodgkin’s 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’s lymphoma. It primarily affects older adults.
- Lymphocyte Depletion Hodgkin’s 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’s lymphoma, and it is seen more often in people who are elderly or have AIDS.
Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma: This rare disease accounts for just 5% of Hodgkin’s lymphoma diagnoses and is most common among men between 35 and 40. Unlike other types of Hodgkin’s lymphoma, it produces no Reed-Sternberg cells. It is usually diagnosed at an early stage and has an excellent survival rate.
Hodgkin's Lymphoma Risk Factors
Anything that increases your chance of getting Hodgkin’s lymphoma is a risk factor. Although Hodgkin’s lymphoma usually develops in people who have no risk factors, the following things may mean you are more likely to develop it:
- Age: Hodgkin’s 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’s lymphoma.
- Viruses: The risk is small, but some viruses may make you more likely to get Hodgkin’s 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’s lymphoma, you have an increased risk of developing the disease.
Not everyone with risk factors gets Hodgkin’s lymphoma. However, if you have risk factors, you should discuss them with your doctor.
Hodgkin’s lymphoma often develops in people between the ages of 16 and 34. These younger patients are usually otherwise healthy. Because of this, their bodies can withstand the disease without showing any symptoms for a long period of time. Other times, the only symptom will be painless swelling of the lymph nodes usually in the neck or under the arm, as well as in the upper chest, abdomen and groin. Patients often visit a physician because of this swelling, which eventually leads to a diagnosis.
Other symptoms vary from person to person and may include:
- Pain in the swollen lymph nodes after drinking alcohol.
- Heavy night sweats, with or without a fever.
- Fever or chills at night or during the day.
- Unexplained weight loss.
- Loss of appetite.
- Fatigue or lack of energy.
- Dry, itchy skin.
- A widespread, red rash.
- Cough and shortness of breath or chest discomfort caused by a large lymph node mass in the chest.
- An enlarged liver or spleen.
These symptoms do not always mean you have Hodgkin’s lymphoma. However it is important to discuss any signs with your doctor, since they may signal other health problems.
Is Hodgkin's Lymphoma Genetic?
In rare cases, Hodgkin's lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Did you know?
Successful treatment depends upon an accurate and precise diagnosis. However, the disease may be hard to diagnose. It is important for a specialist familiar with Hodgkin’s lymphoma to analyze your biopsy.
While most cancer centers see only a few cases of Hodgkin’s lymphoma a year, MD Anderson has an internationally known program that focuses only on the disease. Our pathologists have some of the highest levels of expertise in Hodgkin’s lymphoma you’ll find anywhere. They use the latest technology and techniques to pinpoint disease.
Hodgkin’s Lymphoma Diagnostic Tests
If you have symptoms that may signal Hodgkin’s lymphoma, your doctor will examine you and ask you questions about your health, your lifestyle and family medical history.
One or more of the following tests may be used to find out if you have Hodgkin’s lymphoma. These tests also may help find out if your treatment is working.
- Lymph node biopsy: A small piece of tissue is removed from a lymph node and looked at under a microscope. Sometimes the entire node is removed.
- Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET/CT (positron emission tomography/ computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- Blood tests to evaluate liver and kidney function
- Bone marrow aspiration and biopsy: A thin needle is inserted into the hip or other large bone, and a small sample of cells from tissue inside the bone is collected. The cells are then looked with a microscope.
- Immunophenotyping: Cells from a lymph node, blood or bone marrow are examined with a microscope to determine the type of Hodgkin’s lymphoma cells
- Pulmonary function test: Determines how well the lungs are working
In rare cases, Hodgkin’s lymphoma can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
If you are diagnosed with Hodgkin’s lymphoma, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread. This helps the doctor plan the best way to treat the cancer. Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
(source: National Cancer Institute)
Stage 1 (early stage):
- Stage 1: Cancer is found in one lymph node region
- Stage 1E: Cancer is found outside the lymph system in one organ or area.
Stage 2 (locally advanced disease): Cancer is found in:
- Stage 2: Cancer is found in two or more lymph regions on one side of the diaphragm
- Stage 2E: Cancer is found in one lymph node region plus a nearby area or organ. This is called "extension," or "E" disease
Stage 3 (advanced disease): Cancer is found in:
- Stage 3: Cancer is found lymph nodes above and below the diaphragm
- Stage 3E: Cancer is found in lymph node groups above and below the diaphragm and in a nearby area or organ
- Stage 3S: Cancer is found in lymph node groups above and below the diaphragm and in the spleen
- Stage 3E,S: Cancer is found in lymph node groups above and below the diaphragm, outside the lymph nodes in a nearby organ and in the spleen.
Stage 4 (widespread disease):
Cancer is found:
- outside the lymph nodes throughout one or more organs, and may be in lymph nodes near those organs; or
- outside the lymph nodes in one organ and has spread to areas far away from that organ; or
- in the lung, liver, bone marrow, or cerebrospinal fluid (CSF). The cancer has not spread to the lung, liver, bone marrow, or CSF from nearby areas.
At MD Anderson, our doctors have a full range of methods to help fight Hodgkin’s lymphoma in every stage, including disease that has returned after treatment. We are at the forefront of pioneering targeted therapies and other treatments that help your healthy cells fight cancer, while minimizing the impact to your body.
Because the standard chemotherapy for Hodgkin’s lymphoma may have long-term effects, especially for young people, we are working to develop effective – but more gentle – treatments. In young men and women, we make every effort to preserve fertility by using therapies that focus on treating the cancer but cause the least-possible damage to reproductive organs.
Hodgkin’s Lymphoma Treatments
If you are diagnosed with Hodgkin’s lymphoma, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Type and stage of Hodgkin’s lymphoma
- If your disease has not responded to previous treatments
- If your disease has returned after treatment
- Your age
- Other medical problems, such as heart or kidney disease
Your treatment will be customized to your needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Treatment with drugs is the main therapy for Hodgkin’s lymphoma. Combination chemotherapy, a mixture of drugs with different properties, is used often. MD Anderson offers the most up-to-date and advanced chemotherapy options.
Radiation therapy uses focused beams of energy to kill cancer cells. New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
The Proton Therapy Center at MD Anderson is one of the world’s largest and most advanced centers in the world. It’s the only proton therapy facility in the country located within a comprehensive cancer center. This means that this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.
Proton therapy delivers high radiation doses directly to the tumor site, with minimal damage to nearby healthy tissue. For some patients, this therapy results in more-successful treatment with fewer side effects.
Instead of attacking the disease itself, immunotherapy drugs help the body fight cancer. Sometimes they have fewer side effects than other treatments.
We pioneered several immunotherapies, and several of them are found at only a few other cancer centers. Immunotherapy treatment methods may include:
- Antibodies drug conjugates, such as brentuximab vedotin
- Checkpoint inhibitors, including nivolomab and pebrolizumab
- Biological therapies that develop antibodies that destroy cancer cells
- Targeted therapies that fight cancer cells by using small molecules to block pathways cells use to survive and multiply
Stem Cell Transplantation
If Hodgkin’s lymphoma does not respond to frontline treatments or if it returns, a stem cell transplant may be recommended. These transplants can be either autologous (stem cells taken from the patient) or allogenic (stem cells from a donor).
MD Anderson has the largest bone marrow and stem cell transplant program in the nation, performing roughly 800 procedures per year. We pioneered the use of less toxic doses of chemotherapy, which result in higher success rates and are now the widely accepted standard.
Why choose MD Anderson for your Hodgkin's lymphoma treatment?
Our team of experts is one of the few focused only on lymphoma. While most oncologists see only one or two Hodgkin's 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's 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's 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’s lymphoma, and she was not optimistic.
The Caribbean expatriate had received her first Hodgkin’s 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’s 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’s 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.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
B-Cell Lymphoma Moon Shot
MD Anderson’s B-Cell Lymphoma Moon Shot™ aims to rapidly and dramatically improve treatment outcomes for Hodgkin's lymphoma patients through powerful new treatment approaches and research.Learn more about the B-Cell Lymphoma Moon Shot