Skip to content
GERICLINICS

GeriQBank · Paper III · Q10

Hodgkin Lymphoma

Moderate YieldAsked ×17-mark note
Topic
Haematology, Oncology & Screening
Chapter
Haematology
Years asked
Not recorded in the source
Frequency
Set 1× in Paper III (2009–2025)

As set in the university paper

  • What are the types of Non-Hodgkin’s lymphoma? What are their clinical presentations and prognosis, and what are the principles of therapy?

    Paper III · Haematology & Oncology · asked ×1 · 7-mark note · see in paper list

Detailed answer

Pro · free in beta
Attempt it firstOutline your answer as a 7-mark note before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer

Textbook gap: No Hodgkin lymphoma chapter. Only link: Ch. 26 — actuarial risk of therapy-related MDS/AML is 6–9% after Hodgkin's treatment (vs 17% after myeloma treatment). Geriatric-oncology philosophy from Ch. 26/27 transfers directly.

High-Yield Points

A. Definition & Epidemiology

1.

B-cell derived lymphoid malignancy; malignant cells only 1–2% of tumour mass, surrounded by reactive infiltrate.

2.

Bimodal age distribution — peaks at 15–35 and after 55–60 years; 20–25% of cases occur >60 years.

3.

Elderly HL behaves worse: more advanced stage, more B symptoms, more mixed-cellularity, higher EBV positivity. 5-yr survival falls from >90% (young) to 40–60% (>60).

B. Classification (WHO-HAEM5)

Subtype Frequency Features

Nodular sclerosis ~70% Young adults, mediastinal mass Mixed cellularity 20–25% Older patients, HIV, EBV+ Lymphocyte-depleted <1% Worst prognosis — elderly, HIV, EBV+

4.

Immunophenotype: classic RS cells — CD30+, CD15+, CD45−, CD20 weak/neg. NLPHL "popcorn" cells — CD20+, CD45+, CD30−, CD15− (mirror image).

5.

9p24.1 amplification → PD-L1/PD-L2 overexpression — basis for checkpoint inhibitor efficacy.

C. Clinical Features

6.

Painless, rubbery cervical/supraclavicular lymphadenopathy ± mediastinal mass.

7.

Spreads contiguously node-group to node-group (unlike NHL's unpredictable spread).

8.

B symptoms (fever >38°C, night sweats, weight loss >10%) in 25–30%, more frequent in elderly.

D. Diagnosis & Staging

9.

Excisional lymph node biopsy mandatory — FNA inadequate.

10.

Staging: PET-CT, Lugano/Ann Arbor (I–IV, A/B suffix); bone marrow biopsy usually omitted.

11.

IPS score (advanced disease): albumin <4 g/dL, Hb <10.5 g/dL, male, age ≥45, stage IV, WCC ≥15,000, lymphocytes <600/µL.

Management

Setting Approach

Early favourable 2 cycles ABVD + 20 Gy involved-site RT, or PET-adapted chemo alone Advanced, fit Nivolumab-AVD (new standard, S1826), or BrECADD, or A+AVD Advanced, ≥60 years Nivolumab-AVD now preferred; bleomycin lung toxicity mortality up to 25% in >60 — avoid Frail/unfit Sequential BV→AVD→BV, or attenuated regimens (VEPEMB, PVAG)

Relapsed Salvage → ASCT (fit); checkpoint inhibitors for transplant-ineligible Late effects: secondary MDS/AML (6–9%, per Pathy's), anthracycline cardiomyopathy, radiation-related breast/lung cancer, hypothyroidism, bleomycin pulmonary fibrosis.

Latest Updates (2023–Present)

WHO-HAEM5 repositioned HL among B-cell neoplasms. ICC renamed NLPHL as "NLPBL" — WHO retained NLPHL. SWOG S1826 (older-patient subset, ≥60, JCO 2025): nivolumab-AVD vs BV-AVD — 2-yr PFS 89% vs 64% (HR 0.24), 2-yr OS 96% vs 85%; fewer sepsis episodes and less neuropathy. Contrast with ECHELON-1 where BV-AVD showed NO benefit over 60 — nivolumab-AVD is a genuine breakthrough for older patients. GHSG HD21 (BrECADD): comparable PFS in 61–75 age group but febrile neutropenia 54% vs 13% with nivolumab-AVD — decisive MD Geriatrics – Haematology Compendium Page 21 of 34 difference in frail elderly.

Current Practice Update

Domain Pathy's (2022) Current evidence

Coverage None — only late-effect MDS/AML risk Fully covered by WHO-HAEM5/ESMO/NCCN Advanced-stage Not addressed Nivolumab-AVD (S1826) preferred, especially ≥60 therapy yrs Late effects Correctly states 6–9% secondary MDS/AML risk — still Confirmed; termed MN-pCT under WHO 2022 valid MD Geriatrics – Haematology Compendium Page 22 of 34

How was your recall?

Rating marks the question complete. “Need another pass” also adds it to your bookmarks.

References

Spotted an error or something out of date?Report a problem with this page