Introduction
Hodgkin’s lymphoma is a malignant tumor disease of the lymphatic system with a painless swelling of the lymph nodes. Its prognosis, compared to many other malignant tumors, is associated with high cure rates and depends on the spread of the tumor. Over the last 30 years, significant progress has been made in the treatment of this disease.
Therapeutic measures are adapted according to the stages. In this way, an average of about 80% of all patients with Hodgkin lymphoma can be cured. If the disease is detected in early stages, the cure rate even increases to 90%. Some patients cannot be cured despite advanced therapy options. Alternative treatment methods, such as therapy with targeted antibodies, are currently the subject of research.
Prognosis in early stages 1 and 2 of lymphoma
In stage I of the Ann-Arbor classification, Hodgkin’s lymphoma is restricted to a single lymph node region. The current treatment guidelines for Hodgkin’s lymphoma without risk factors provide for chemotherapy in two cycles followed by radiation. In stage II of the Ann-Arbor classification, Hodgkin’s lymphoma has affected at least two or more lymph node regions on one side of the diaphragm.
Even in case of Hodgkin’s lymphoma II without risk factors, current guidelines recommend chemotherapy consisting of two cycles followed by radiation. Both stages are further divided into A and B. This is related to the presence of the so-called B symptoms, i.e. the occurrence of fever, night sweats and weight loss.
The so-called intermediate stages with one or more risk factors, the treatment currently consists of four cycles of chemotherapy followed by radiation. In the early stages of Hodgkin’s lymphoma, the cure rate after a period of five years is around 90%. Survival rates within the same period are 95%.
Chemo- and radiotherapeutic measures, especially in high doses, are not without side effects. Approximately 15% of patients suffer from late complications in the course of 10 to 20 years. These include primarily secondary neoplasia (occurrence of another tumor) such as breast cancer or thyroid cancer, but also heart disease.
Such therapy-related sequelae play an important role especially in early-stage Hodgkin lymphomas. As a result of good healing prospects, the risk of dying of a late complication is comparatively higher. After about 15 years, the annual probability of the occurrence of therapy-related diseases is about 1%.
Criteria for a tendency towards a worse prognosis of early Hodgkin’s lymphoma are a large tumor in the mediastinum (tissue area located in the thoracic cavity), more than three affected lymph node regions, a high blood sedimentation rate and B-symptoms, and age over 50. In stage III of the Ann-Arbor classification, at least two or more lymph node regions not only on one but on both sides of the diaphragm are affected by non-Hodgkin’s lymphoma. In stage IV of the Ann-Arbor classification, there is extensive involvement of organs such as the liver and lungs as well as tissue infiltrations.
Lymph nodes may also be affected. The usual therapy in the advanced stages is chemotherapy consisting of six cycles. Subsequently, a radiotherapy treatment can be applied to destroy the remaining malignant tissue.
The treatment regimen differs depending on age, spread and risk factors. In the advanced stages, the cure rates in the first five years after diagnosis vary between slightly more than 50% and 80%, while survival rates are between 80% and 90%. Varying prognostic factors, as well as the different treatment regimens used, explain the wide range of 5-year survival rates.
