hodgkin's lymphoma | AdulteHodgkin's lymphoma in adult Hodgkin's lymphoma

AdulteHodgkin's lymphoma in adult Hodgkin's lymphoma

Summary
Hodgkin's lymphoma is a malignant hemopathy characterized by the presence of Reed-Sternberg cells, whose lymphoid origin is demonstrated, but whose cause remains unknown. The extension balance specifying the invaded ganglion and/or visceral territories, the tumor volume, and the analysis of prognostic factors are an essential step in defining the necessary treatment and reducing the risks. Exclusive radiotherapy is no longer recommended for treating localized stages without adverse factors. Initial chemotherapy is indicated for all forms of classical Hodgkin lymphoma; The ABVD protocol is the international standard treatment. The localized stages SUS-diaphragmatic are treated by a chemotherapy-radiotherapy association of the ganglion territories initially reached; Optimal treatment modalities (duration of chemotherapy, doses of irradiation) are evaluated in therapeutic trials. The scattered stages are treated by eight cycles of exclusive chemotherapy, subject to a remission obtained after six cycles; The indications of radiation therapy are reduced and specific. The early evaluation of the response to chemotherapy helps to identify the wrong answering patients, for whom a modification of the expected treatment is necessary. High-dose chemotherapy associated with autografting of hematopoietic stem cells improves the prognosis of relapses. The evaluation of modern imaging methods and their impact on treatment justify prospective studies. Prolonged surveillance remains necessary, oriented after 5 years towards the detection of late complications.

Abstract
The diagnosis of Hodgkin's lymphoma is based on the identification of the Reed-Sternberg cell. The Immunophenotype and genotype of reed-Sternberg cells have been analyzed by recent techniques, showing that, in many cases, reed-Sternberg cells are of lymphoid origin. The cause of Hodgkin's lymphoma remains unknown. The purpose of initial staging is to define the limit of detectable disease and prognostic factors for treatment decision. Radiation therapy alone is no longer recommended to treat clinical stages I and II without risk factors. Front-line chemotherapy, with ABVD regimen as gold standard, is indicated for all clinical stages with or without risk factors. Combined modality treatment with radiation therapy delivered only to initially involved areas, is the treatment of choice for localized stages with supradiaphragmatic disease. Chemotherapy alone, with doxorubicin-containing regimen given for 8 cycles, has been defined as standard treatment for advanced stages, provided a remission is achieved after initial Chemotherapy (4-6 cycles). Recent trials in Europe have contributed to a better definition of the role of radiation therapy in specific indications. Restaging after initial chemotherapy is of importance to evaluate the degree of response and may be used to determine whether more or different treatment is indicated. The impact of new imaging techniques on medical decision making needs to be prospectively evaluated. High-dose chemotherapy with hematopoietic stem cell transplant may improve the prognosis of relapsed patients. Treatment of patients in prospective trials is highly commendable. Follow-up evaluation is liked at identifying long-term toxicity.