Lymphome de Hodgkin de l’adulte

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 analysed 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 aimed at identifying long-term toxicity.