Hodgkin’s lymphoma
Journal Title: Postępy Nauk Medycznych - Year 2012, Vol 25, Issue 9
Abstract
Hodgkin’s lymphoma (HL) is a chemosensitive B-cell malignant proliferation, with durable remission rates 80-90% among all treated patients. Approximately 95% of cases represent so called classical HL (cHL), whereas in the remain 5% of cases – nodular lymphocyte predominant HL (nLP HL).<br>Neoplastic cells in HL (Hodgkin/Reed-Sternberg cells – H/RS) are characterized by several molecular defects, leading to escape from apoptosis, with simultaneous clonal proliferation. H/RS cells in cHL show expression of CD30 and CD15 antigens, with lack of CD45 and EMA (epithelial membrane antigen). Moreover, they show overexpression of Bcl-2, p53, p21 or PCNA proteins, what is associated with worse prognosis in this disease. In contrast, H/RS cells in nL PHL have different immunophenotype. They show expression of B-cell markers (CD20+), somatic mutations of immunoglobulin heavy chains and expression of Bcl-6 protein.<br>Actually, polychemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) provides the best balance of effectiveness and minimization of toxicity the front-line treatment. In majority of patients chemotherapy is followed by involved-field radiotherapy for early stages and long-term chemotherapy (combined modality treatment). The major goal of current clinical research in HL is optimizing treatment to limit irreversible acute and late toxicity such as infertility, cardiac disease, pulmonary dysfunction, and a risk of second neoplasms. In primary resistant or recurrent patients, the high dose chemotherapy followed by autologous stem cell transplantation (autoSCT) are actually standard of care. Treatment beyound autoSCT still remains challenge for oncohematologists. The paper reviews an actual view on the pathogenesis and standards of first-line treatment in classic HL have been described.
Authors and Affiliations
Piotr Smolewski
Keywords
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