Hodgkin Lymphoma (HL)

Hodgkin lymphoma is a cancer of the lymphatic system that mostly affects teenagers and young adults; it is less common in younger children. More than 95% of children and teenagers with Hodgkin lymphoma are cured.

Causes

The exact cause is unknown. Previous Epstein–Barr virus infection, a weakened immune system and a family history of Hodgkin lymphoma slightly increase the risk.

Symptoms

• Painless swelling of lymph nodes, usually in the neck or above the collarbone
• Cough or breathlessness from enlarged nodes in the chest
• Fever, drenching night sweats and weight loss (B symptoms)
• Tiredness and itching

Stages

Stages I–IV describe how far the lymphoma has spread, from one lymph-node area to spread into organs such as the lungs, liver or bone marrow.

Complications and late effects

Because children have many years ahead of them, treatment is planned to limit late effects on the heart, lungs, thyroid, fertility and the risk of second cancers.

Prognosis

Excellent: the great majority of children are cured, and relapses are often cured with further treatment.

A biopsy confirms the diagnosis, and staging scans decide the treatment group.

Blood and urine tests

Blood count, ESR, liver and kidney function and other baseline tests.

Lymph node biopsy

A whole lymph node or a core sample is examined for Reed–Sternberg cells.

Imaging tests

• PET-CT — for staging and to assess response after the first cycles
• CT or MRI — detailed pictures of the neck, chest, abdomen and pelvis
• Chest X-ray — to measure a large chest mass

Bone marrow aspiration and biopsy

Only in selected children with advanced disease.

Staging

The stage (I–IV) is combined with letters: A or B (absence or presence of B symptoms), E (extension to an organ next to a node) and S (spleen involvement).

Modern pediatric protocols adapt treatment to the early PET response, so children who respond quickly can avoid radiotherapy.

Chemotherapy

Combination chemotherapy in cycles (for example OEPA / COPDAC-type regimens).

Immunotherapy and targeted therapy

Brentuximab vedotin (anti-CD30) and checkpoint inhibitors are used in higher-risk or relapsed disease.

Radiotherapy

Low-dose, targeted radiation only for areas that respond slowly.

Bone marrow transplant

High-dose chemotherapy with an autologous transplant for relapsed or refractory disease.

Surgery

Used for biopsy; very rarely for treatment.

Follow-up care

Regular visits to check for relapse and for late effects, with support for school, sports and emotional wellbeing.

Our pediatric and adolescent lymphoma team cares for young people with Hodgkin lymphoma.