Q. What is the importance of cellular classification?

A. Hodgkin's disease is histologically classified as :-

• Lymphocytic predominance.
• Nodular sclerosis.
• Mixed cellularity.
• Lymphocyte depletion.
• Unclassified

Patients with lymphocyte predominance, generally have localized disease, are usually asymptomatic and can be cured with less intensive therapy as compared with other subtypes. They are also at a higher risk of secondary malignancy.

However, determining the histologic subtype is not as important as in Non - Hodgkin's lymphoma, as with effective multiagent chemotherapy, histologic subtype does not influence the outcome.

Q. What is the treatment available?

A. More than 90% of all children with newly diagnosed Hodgkin's disease are curable with modern therapy. Multiagent chemotherapy alone or with relatively low dose field radiation is used to treat children in all stages. Historically, radiation alone was used to cure stage I, II, III disease. However, with the potential for secondary malignancies (solid tumors, breast cancer), irradiated field growth retardation and benign and malignant changes in the thyroid, radiation therapy alone has been discarded. However, patients with massive mediastinal disease (> than 1/3rd the maximal thoracic diameter, or tumor involving the pericardium or chest wall), should be treated with chemotherapy and radiotherapy, even if they have stage I or II disease.

Adolescent patients who have achieved maximum growth and have localized childhood Hodgkin's disease (pathologically staged I and II) may be treated as adults with standard dose radiation alone.

The various chemotherapy protocols used are :-

• MOPP - mechlorethamine, vincristine, prednisolone and procarbazine.
• ABVD - Doxorubicin, Bleomycin, Vinblastine and Dacarbazine.
• VEEP - Vincristine, Etoposide, Epirubicin and Prednisolone.
• Stage I and II a - Treatment includes

Combination chemotherapy with or without low dose radiation to involved fields.

• Stage II B - Treatment is controversial. Combined modality therapy is preferred.
• Stage III A - Combined modality therapy.
• Stage III B & IV - Chemotherapy + full dose involved field radiotherapy.

Q. What are the chances of a relapse?

A. Most of the relapses occur within the first 3 years. Patients whose disease recurred after radiation alone may be considered for chemotherapy: e.g. with MOPP, ABVD or other combinations. Those treated with one chemotherapy regimen may be considered for alternative chemotherapy and radiation.

Autologous bone marrow may be most useful in patients in second remission with chemotherapy.

See the biochemical profile in disseminated lymphoma