Page 1629 - Williams Hematology ( PDFDrive )

1604 Part XI: Malignant Lymphoid Diseases Chapter 97: Hodgkin Lymphoma 1605

23
TABLE 97–1. Classification of Hodgkin Lymphoma and colleagues represented another major advance. Based on a more
favorable safety profile and greater efficacy, ABVD replaced MOPP.
Histologic Subtype Immunophenotype
Nodular CD20+ CD30− CD15− Ig+ EPIDEMIOLOGY
lymphocyte-predominant
Classical CD20−* CD30+ CD15+ Ig− The estimated incidence of Hodgkin lymphoma in the United States was
9190 cases in 2014, with equal incidences in Americans of European and
Nodular sclerosis
African descent (2.9/100,000). The disease has a median age of onset
24
Mixed cellularity of 38 years with bimodal incidence peaks at ages 15 to 34 and older
25
Lymphocyte-rich than age 60 years (Fig. 97–1). The second incidence peak is smaller in
Americans of European descent whereas it is more prominent in Amer-
Lymphocyte-depleted
24
icans of Hispanic descent. Except for Americans of Asian descent, for
Ig, immunoglobulin. whom the incidence has increased by 5.2 percent per year, the incidence
*Infrequently positive. of Hodgkin lymphoma has been stable in the United States from 1975 to
2011 (Fig. 97–2). The nodular sclerosis subtype predominates in young
adults, whereas the mixed cellularity subtype is more common in the
pediatric population and at older ages. There is a male predominance
findings with prognosis. A second advance was made in 1966 when at all ages (~1.4:1).
8
Lukes, Butler, and Hicks proposed a classification that related well to Early studies associated an increased risk of Hodgkin lymphoma
26
clinical presentation and course. Their proposal was slightly modi- in the young adult population with high socioeconomic status. Living
9
fied into the Rye classification, in which four histopathologic subtypes in a rental home, sharing a bedroom, and attending daycare or nursery
were described: lymphocyte-predominant, nodular sclerosis, mixed school and early parity in women have been associated with reduced
cellularity, and lymphocyte-depleted. In the World Health Organi- risk. The relationship of incidence to neighborhood socioeconomic
zation Classification of Lymphoid Neoplasms, the NLPHL subtype is status was demonstrated in California for younger but not for older
25
clearly distinguished from cHL. The “lymphocyte-rich” subtype of patients. Although associations with occupational exposure to pesti-
10
cHL was introduced in 1999. cides and lifestyle factors such as cigarette smoking have been reported,
Peters described a clinical staging system in 1950, emphasizing the aggregate data do not indicate consistent causal relationships with
the diagnostic evaluation of the anatomic extent of disease. In 1952, exogenous chemicals or toxins. A personal or family history of an auto-
11
Kinmouth introduced lower-extremity lymphangiography that allowed immune disorder, particularly sarcoidosis, has been associated with an
27
roentgenologic visualization of the pelvic and retroperitoneal lymph increased risk of Hodgkin lymphoma. Shared etiologic factors with
nodes and was found to be far more sensitive than palpation or other multiple sclerosis have been suggested but these are thought to be of
radiographic methods. The frequency of unsuspected splenic involve- minor importance.
12
ment was revealed in a group of 65 patients subjected to laparotomy Geographic patterns vary for the three major age groups: the inci-
and splenectomy with biopsy of splenic hilar, paraaortic and mesenteric dence of Hodgkin lymphoma is greater in childhood in less-developed
nodes, and liver at Stanford University. These diagnostic procedures countries, whereas the incidence peaks in young adulthood and is asso-
13
28
led to improved understanding of the mode of dissemination of the ciated with more favorable histologic subtypes in developed countries.
disease and correlated well with prognosis, culminating in the modern Presence of the Epstein-Barr virus (EBV) in Hodgkin and Reed-Stern-
concepts of staging codified at the Rye, New York, conference in 1965, berg cells is more common in less-developed countries and in pediatric
14
and further refined at the Workshop on the Staging of Hodgkin’s Dis- and older adult cases. The worldwide incidence of the disease is much
ease in Ann Arbor, Michigan, in 1971. 15 lower in the Asian population, whether residing in the Far East or in the
Pusey (1902) and Senn (1903) were the first to report dramatic United States, although the reported rate in Vancouver, Canada, among
17
16
regressions of lymphadenopathy with exposure to X-rays, discovered
by Roentgen in 1896. Based upon the nearly inevitable recurrence in 6
untreated areas, Gilbert proposed the systematic treatment of both Male
involved and uninvolved areas in 1939. Peters (1950) is credited for 5
18
the first demonstration of the curative potential of radiotherapy in her
classic paper. The development of megavoltage radiotherapy (doses 4 Female
11
>4000 cGy), as reported by Kaplan in 1962, permitted the delivery of
19
tumoricidal doses to virtually all lymphoid regions in the body within Incidence rate per 100,000 3
acceptable limits of normal tissue tolerance. 2
The chemotherapy of cHL originated as a byproduct of the war-
time work on the mustard gases. 20,21 Following the initial work with 1
the nitrogen mustards, antimetabolites were synthesized and a number
of alkaloids and antibiotics extracted from various plant, fungus, and 0
microbial sources became available for clinical use. DeVita and col- <20 20–49 50–64 65–74 75+
leagues introduced the first highly effective combination chemotherapy, Age
MOPP (mechlorethamine [nitrogen mustard], vincristine [Oncovin],
procarbazine, and prednisone), based on experimental studies indicat- Figure 97–1. The graph depicts the incidence of Hodgkin lymphoma
ing the desirability of combining agents with non-overlapping toxici- as a function of age among American males and females, 2000 to 2011.
(Data from the Surveillance, Epidemiology, and End Results (SEER) Program
ties. Combination chemotherapy extended the curative potential for (www.seer.cancer.gov) Research Data (1973-2011), National Cancer Insti-
22
cHL to advanced disease. The ABVD (doxorubicin [Adriamycin], ble- tute, DCCPS, Surveillance Research Program, Surveillance Systems Branch,
omycin, vinblastine, dacarbazine) regimen introduced by Bonadonna released April 2014, based on the November 2013 submission; 2014.)

Kaushansky_chapter 97_p1603-1624.indd 1604 9/18/15 11:10 PM