Hodgkin’s Disease: Classification

The following histological types of Hodgkin’s disease are distinguished:

  • Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) 5 %.
  • Classical Hodgkin lymphoma with
    • Nodular sclerosing type (NSHL) (circa 60%).
    • Mixed type (MCHL) (circa 30 %)
    • Lymphocyte-rich type (circa 4 %)
    • Lymphocyte-poor type (< 1%)

Based on the findings of clinical staging, but independent of histologic type, Hodgkin lymphoma is classified into the following four stages according to the Ann Arbor classification:

Stage Features
I Involvement of a lymph node region or involvement of an extralymphatic (“outside the lymph nodes”) organ/district
II Involvement of ≥ 2 lymph node regions or localized involvement of an extralymphoid organ/district and its lymph nodes on one side of the diaphragm
III Involvement of ≥ 2 lymph node regions or extralymphoid organs/districts on either side of diaphragm

  • III1: Lymph node involvement above the truncus coeliacus.
  • III2: Lymph node involvement below the truncus coeliacus.
IV Disseminated (“spreading”) organ infestation
A No defined general symptoms
B Defined general symptoms (B symptoms).

  • Unexplained, persistent, or recurrent fever (>38°C).
  • Severe night sweats (wet hair, soaked sleepwear).
  • Unwanted weight loss (> 10% percent of body weight within 6 months).

Based on the above, patients are divided into risk groups:

Risk groups Stages according to the Ann Arbor classification
Early stages
  • Stage I A o. B and II A o. B according to Ann-Arbor without risk factors.
Middle stages(intermediate stage)
  • Stage I A o. B and stage II A with one or more risk factors.
  • Stage II B when the risk factors high ESR and/or ≥ 3 lymph node areas are present.
Advanced stages
  • Stage II B, if the risk factors E-involvement (extranodal involvement) u./o. large mediastinal tumor are present.
  • Stage III A o. B
  • Stage IV A o. B

According to this classification, therapy is carried out according to the stage.