Hodgkin lymphoma Histologic subtypes: - Nodular sclerosing - Mixed cellularity - Lymphocyte predominance -Lymphocyte depleted new category: - Lymphocyte rich

Recommended Procedures for Staging of Hodgkin’s Patients History and examination  Identification of B symptoms

Recommended Procedures for Staging of Hodgkin’s Patients History and examination  Identification of B symptoms Radiologic procedures  Plain chest x-rays  Computed tomograpy of thorax  Computed tomograpy of abdomen and pelvis

Recommended Procedures for Staging of Hodgkin’s Patients History and examination  Identification of B symptoms Radiologic procedures  Plain chest x-rays  Computed tomograpy of thorax  Computed tomograpy of abdomen and pelvis Hematologic procedures  Full blood count with differential count  Determination of erythrocyte sedimentation rate  Bilateral bone marrow aspiration and biopsy

Recommended Procedures for Staging of Hodgkin’s Patients History and examination  Identification of B symptoms Radiologic procedures  Plain chest x-rays  Computed tomograpy of thorax  Computed tomograpy of abdomen and pelvis Hematologic procedures  Full blood count with differential count  Determination of erythrocyte sedimentation rate  Bilateral bone marrow aspiration and biopsy Biochemical procedures  Liver function tests  Serum albumin, lactate dehydrogenase, and calcium measurements

Recommended Procedures for Staging of Hodgkin’s Patients History and examination  Identification of B symptoms Radiologic procedures  Plain chest x-rays  Computed tomograpy of thorax  Computed tomograpy of abdomen and pelvis Hematologic procedures  Full blood count with differential count  Determination of erythrocyte sedimentation rate  Bilateral bone marrow aspiration and biopsy Biochemical procedures  Liver function tests  Serum albumin, lactate dehydrogenase, and calcium measurements Procedures for use under special circumstances  Ultrasound scanning  Magnetic resonance imaging  P E T  Gallium scanning

Ann Arbor Staging Classification for Hodgkin’s Disease Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (I E )

Ann Arbor Staging Classification for Hodgkin’s Disease Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (I E ) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (II E )

Ann Arbor Staging Classification for Hodgkin’s Disease Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (I E ) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (II E ) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E ), spleen (III S ), or both (III SE )

Ann Arbor Staging Classification for Hodgkin’s Disease Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (I E ) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (II E ) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E ), spleen (III S ), or both (III SE ) Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph-node involvement; the organ(s) involved should be identified by a symbol: (P) pulmonary, (O) osseous, or (H) hepatic.

Ann Arbor Staging Classification for Hodgkin’s Disease Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (I E ) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (II E ) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E ), spleen (III S ), or both (III SE ) Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph-node involvement; the organ(s) involved should be identified by a symbol: (P) pulmonary, (O) osseous, or (H) hepatic. In addition, (A) indicates an asymptomatic patient; (B) indicates the presence of fever, night sweats, or weight loss > 10% of body weight. Adapted from Hellman S, Jaffe ES, DeVita VT: Hodgkin’s disease, in DeVita VT Jr, Hellman S, Rosenberg SA (eds): Cancer: Principles and Practice of Oncology, p Philadelphia, JB Lippincott, 1989

Radiotherapy Chemiotherapy A B M T

Hodgkin lymphoma Radiotherapy: Involved field radiotherapy (IFRT): 35 to 44 Gy 150 – 200 cGy per daily (5 days per week)

Radiotherapy Chemiotherapy A B M T

Hodgkin lymphoma Treatment: stage IA, IB, IIA: 4xABVD (IFRT) IIB, IIIA, IIIB, IVA, IVB: 6-8xABVD (BEACOPP) (+ IFRT)

Radiotherapy Chemiotherapy A B M T