Hodgkin Lymphoma: What You Need To Know

Hodgkin lymphoma affects the lymphatic system, the network of tissues and organs that help the body fight infection. Although it's not as common as other cancers, Hodgkin lymphoma is highly treatable — especially when found early.

Waled Bahaj, MD, a BMT/cellular therapist at Franciscan Health Cancer Center Indiana Blood & Marrow Transplantation, explains what patients need to know about the symptoms, diagnosis and treatment of Hodgkin lymphoma.

Key Takeaways: Hodgkin Lymphoma

• Symptoms that raise red flags: Unexplained fevers, night sweats, weight loss, fatigue or swollen lymph nodes are some of the first signs that may prompt an evaluation for Hodgkin lymphoma.
• Diagnosis depends on a biopsy: While imaging tests can help determine the stage of disease, a biopsy of a lymph node or affected tissue is the only way to confirm Hodgkin lymphoma.
• Treatment often involves chemotherapy combinations: The long-standing ABVD regimen is still a standard option, but newer approaches — like AVD or N+AVD, which adds immunotherapy with nivolumab — may be used, especially in advanced cases.
• The outlook is hopeful: With modern therapies, most people with Hodgkin lymphoma respond well to treatment, and survival rates are among the highest for blood cancers.

What Is Hodgkin Lymphoma?

Hodgkin lymphoma develops when healthy cells in the body's lymphatic system change and grow out of control. The disease is one of two main types of lymphoma, a form of cancer that begins in white blood cells called lymphocytes. The other main type of lymphoma, non-Hodgkin lymphoma, is more common but harder to treat.

The key difference between Hodgkin and non-Hodgkin lymphoma is the type of cell involved. If you have a specific type of cell called a Reed-Sternberg cell, the cancer is classified as Hodgkin. If Reed-Sternberg cells are not present, it's classified as non-Hodgkin.

Although experts aren't sure what causes Hodgkin lymphoma, they do note some risk factors for the disease, including:

• A family history of Hodgkin lymphoma
• HIV infection
• Past infection with Epstein-Barr virus (EBV)
• Your age, with most diagnoses occurring in people in their 20s or 30s, or over age 65
• Your gender, with men more likely to develop the disease than women

Hodgkin Lymphoma Symptoms

One of the first signs of Hodgkin lymphoma is typically a painless swelling of the lymph nodes in the neck, armpit or groin. But there can be other symptoms, too.

"The so-called B symptoms — fever, chills, night sweats, fatigue and unexplained weight loss — are common," Dr. Bahaj said. "Sometimes, people also develop shortness of breath or difficulty sweating."

Another sign of Hodgkin lymphoma is itchy skin, usually in combination with other symptoms. That leads to an important point about Hodgkin lymphoma symptoms, Dr. Bahaj said. Because they can overlap with other, less serious conditions, it's vital to see your doctor if they occur in combination, persist or worsen.

How Hodgkin Lymphoma Is Diagnosed

Most of the time, Hodgkin lymphoma diagnosis begins with a physical exam and imaging tests. The physical exam checks for swollen lymph nodes in the body. The imaging tests look for signs of lymphoma in the body. But the main method to diagnose Hodgkin lymphoma is biopsy, which involves removing a small piece of lymph node tissue to look for the presence of Reed-Sternberg cells.

If Hodgkin lymphoma is diagnosed, results of these tests also provide your doctor with more information about the stage of your cancer, such as whether it affects just the lymph nodes or has spread to other parts of the body. The stage of your cancer will guide your treatment.

Hodgkin Lymphoma Treatments

There are many types of treatments for Hodgkin lymphoma, including radiation therapy, immunotherapy, targeted therapy and bone marrow transplant (also called stem cell transplant). Your doctor will usually start with a combination of chemotherapy drugs, Dr. Bahaj said, or chemotherapy paired with another treatment like radiation therapy.

Your treatment will depend on the type of Hodgkin lymphoma you have, its stage and other factors, including your overall health.

Chemotherapy

The most common chemotherapy regimen for early-stage Hodgkin lymphoma is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine).

"The standard treatment has been ABVD, which combines four chemotherapy drugs," Dr. Bahaj explained. "But in many cases, we now use AVD, which removes bleomycin to reduce toxicity. For advanced stages, there's an exciting, newer option called N+AVD —nivolumab with AVD — which has shown better outcomes than older regimens."

N+AVD has begun to replace a previous standard for treating advanced-stage disease, BV-AVD (brentuximab vedotin with AVD), because of improved, progression-free survival and fewer side effects.

Radiation therapy

Your doctor may recommend involved-site radiation therapy (ISRT) to target affected lymph nodes and the nearby areas where cancer may have spread for early-stage disease. Usually, we combine it with chemotherapy.

For Hodgkin lymphoma that's advanced, radiation therapy is used only in certain situations, such as when cancer returns.

Bone marrow transplant

Also called a stem cell transplant, a bone marrow transplant removes blood stem cells from the body and stores them. Then, we deliver high doses of chemotherapy and radiation therapy to destroy cancer cells. Finally, we return the stored stem cells to the body to help build healthy bone marrow.

A bone marrow transplant may be an option if Hodgkin lymphoma returns or doesn't respond to other treatments.

Targeted therapy and immunotherapy

Targeted therapies attack specific chemicals in cancer cells, causing them to die. Often, we combine targeted therapy with chemotherapy.

Immunotherapy helps turn on the immune system to target and kill cancer cells in the body. Your doctor may recommend immunotherapy if your cancer hasn't responded to other forms of treatment.

Your doctor may recommend:

• Brentuximab vedotin (BV) and PD-1 inhibitors (nivolumab, pembrolizumab) — These options may be used for cancer that returns or for advanced-stage disease.
• BV-nivolumab combinations and other regimens — These options may be used for cancer that returns or for people who aren't candidates for a kind of chemotherapy drug called anthracycline.

Learn more about these treatment options and others for lymphoma.

When To See A Doctor

If you have ongoing symptoms that worry you, like persistent lymph node swelling, it's time to call the doctor.

"Don't ignore your symptoms," Dr. Bahaj said. "The earlier we diagnose Hodgkin lymphoma, the better we can treat it."

Hope And Healing At Franciscan Health

Thanks to early detection and emerging therapies for Hodgkin lymphoma, treatment is more successful and accessible than ever before.

At Franciscan Health, we guide patients through every step of their journey — from diagnosis to treatment to survivorship — with expertise and compassion.

Learn more about lymphoma care at Franciscan Health. You can also request an appointment.