Hodgkin's disease: impact on childbearing

Although Hodgkin's disease is considered one of the "curable" cancers, the high cure rates associated with this disease are not accomplished without risk of potentially severe, immediate, and late side effects. Because the predominant histologic subtype of Hodgkin's disease found in the United States generally affects the 15- to 25-year-old age group, the disease, its treatment, and the side effects of treatment will affect many women of childbearing age. The treatment and its effects on the patient and offspring, including posttreatment fertility, are key issues for perinatal nurses.     

Hodgkin's disease: a clinicopathologic study

One hundred and four cases of Hodgkin's disease diagnosed between July 1981 and June 1991 have been analysed. There was a definite male preponderance. Majority of the patients (82.7%) were below the age of 50 years. Mixed cellularity was the most common type (57.7%). It was followed by both nodular sclerosis and lymphocyte predominant types (16.3% each). Lymphocyte depletion Hodgkin's disease, the most aggressive variant, was the least common (9.7%). The detailed observations, as compared to the previous studies in this region as well as in other parts of the world have been presented and discussed.     

Cytogenetics of Hodgkin's disease

Cytogenetic studies over the past 35 years have made a major contribution towards the understanding of the nature of Hodgkin's disease by demonstrating unequivocally the consistent presence of a clonal population of cells that have the cardinal features of malignancy e.g. more or less gross aneuploidy, frequently with complex chromosomal changes and showing considerable variation from case to case, thus comparable to the findings in carcinomas and other solid cancers. The mode is frequently in the triploid-tetraploid region, as we found in 17 of 27 cases studied in this laboratory by Feulgen microspectrophotometry, compared to only 10 cases with neardiploid modes. It is disappointing that no specific change, such as a translocation that could give a clue to the chromosomal location of a gene or genes involved in the etiology of Hodgkin's disease, has yet been found. Nevertheless it is clear that a number of nonrandom changes, including several that are also common in other malignancies including the non-Hodgkin's lymphomas, are frequently present, e.g., deletions of 1p, 6q, and 7q. Interestingly, deletions of 4q, with loss of 4q25 --> q27, that have also been reported may show some specificity for Hodgkin's disease.     

Hodgkin's disease: a cytokine-producing tumor--a review

Cytokines and hematopoietic growth factors are actively involved in regulation of proliferation, differentiation, and cellular functions of various cell lineages. Each cytokine exhibits pleiotropic biological functions on different target cells and subfamilies of cytokines often have redundant biological effects on the same target cell. Hodgkin's disease represents one of the most common human lymphoma entities, the molecular pathogenesis of which is not well understood. Hodgkin's disease is characterized by the presence of typical, presumed malignant Hodgkin and Reed-Sternberg cells in a hyperplastic background of normal reactive lymphocytes, plasma cells, histiocytes, neutrophils, eosinophils, and stromal cells. The histopathological presentation and characteristic clinical features of Hodgkin's disease correlate with an unbalanced production of multiple cytokines. Hodgkin and Reed-Sternberg cells express mRNA and proteins of various cytokines, growth factors, and cytokine receptors, implying a predominant role for cytokines in the pathophysiology of Hodgkin's disease as a tumor of cytokine-producing cells.     

Polyneuropathy in the course of Hodgkin's disease: case report

Polyneuropathy in neoplastic process practically may occur in every stage, before clinical signs, together with clinical signs and in the last period. In some percent of patients polyneuropathy may outstrip manifestation of neoplastic process even for many years. We present a 61-year-old patient in whom signs of polyneuropathy appeared before the signs of essential disease - Hodgkin's disease. Our case confirms the necessity of very careful and precise diagnostics of polyneuropathy with unclear aetiology.     

Hodgkin's disease in siblings

An incidence survey of Hodgkin's disease in Greater Boston during 1959-1973 detected five sibling pairs under the age of 45. The expected number is 0.7; thus, siblings of young adults with Hodgkin's disease have about a sevenfold excess risk of the disease (P = 0.0008). Eight sibling pairs, not in the incidence series, were also identified. Among all 13 pairs, 12 were sex concordant; the number expected is 6.8 (P = 0.01). The literature includes 46 sibling pairs under 45 of which 30 are sex concordant. The expected number is 23.9 (P = 0.05). Combining the present and the literature series suggests that siblings of the same sex as an affected person have a risk of Hodgkin's disease double that of siblings of the opposite sex. The sex concordance suggests that the excess Hodgkin's disease among siblings of affected persons is due either to inter-personal transmission of an etiologic agent by prolonged or intimate contact or to common-source exposures.     

Epstein-Barr virus and Hodgkin's disease: further evidence for the three disease hypothesis

The epidemiology of Hodgkin's disease suggests that it is a heterogeneous condition comprising more than one disease entity. The Epstein-Barr virus (EBV) is present in the Reed-Sternberg cells of a proportion of cases and is likely to play a role in the pathogenesis of these cases. In this study we show that EBV association rates vary with age at diagnosis. We suggest that Hodgkin's disease can be divided into three disease entities on the basis of EBV association and age, thereby providing biological support for the multiple aetiology hypothesis proposed by MacMahon (Cancer Res 1966; 26: 1189-1290).     

Hodgkin's disease complicated by the nephrotic syndrome

A 12-year-old boy with nodular sclerosis Hodgkin's disease demonstrated nephrotic syndrome. A renal biopsy studied with light microscopy, electron microscopy, and immunofluorescence showed minimal change glomerulonephritis and some foci of fluorescence with anti-IgM. A literature review revealed that 35 cases of Hodgkin's disease with nephrotic syndrome have been reported. Possible etiologic mechanisms are discussed.     

Progressive disease after ABMT for Hodgkin's disease

A major limitation of ABMT for relapsed/refractory Hodgkin's disease is disease recurrence post-transplantation. We retrospectively reviewed 68 patients undergoing ABMT from January 1987 to June 1993. All received a uniform preparatory regimen (CBV). The median patient age was 30; 75% received prior radiation therapy and all patients received prior chemotherapy. Thirty-one percent presented at the time of transplantation with tumor masses larger than 10 cm. Sixty-two percent received autologous marrow alone and 38% PBPC with or without autologous bone marrow. Overall and progression-free survival are 43 and 36% at 5 years. Median follow-up for survivors is 59 months. Multivariate analysis revealed that tumor bulk was the most powerful poor prognostic factor for both survival and progression-free survival. Those transplanted with non-bulky tumors had an overall survival and progression-free survival of 52 and 44%, respectively, compared to those transplanted with bulky tumors who had an overall survival and progression-free survival of 22 and 16% (P = 0.03 and P = 0.04, respectively). Twenty-seven patients have relapsed. Four relapsed more than 2 years after ABMT. Four of the 27 patients who have relapsed remain alive, two without evidence of disease. The time after transplant to relapse was prognostically important, with no patients who relapsed within 6 months of ABMT still being alive, compared with 25% of patients who relapsed 7 or more months after ABMT who are still alive. We conclude that salvage therapy for relapse after ABMT is appropriate, as some patients may achieve prolonged survival. The time from transplant to relapse is an important survival predictor.     

Certain features of the morphology of Hodgkin's disease

Investigation of lymphogranulomatosis process in 42 patients included histological examinations of chains of lymph nodes with varying duration of their involvement. Lymphogranulomatosis was shown to begin with focal involvement of lymph nodes. The specific focus is initially located in the paracortical zone, then the pathological process extends into the medullary zone and finally into the cortical zone. As early and finally into the cortical zone. As early as the focal lesions occur the cell composition already corresponds to one of histological variants of lymphogranulomatosis (by Lukes' classification). No transition from variants with lymphoid prevalence to those with lymphoid exhaustion in groups of removed lymph nodes from the same patient was observed indicating independent development of each histological type and its stability for a given patient. No correlation between the clinical stage and morphological type of lymphogranulomatosis was established.     

Recent advances in the treatment of Hodgkin's disease

Most patients who present with Hodgkin's disease today can be cured of their disease. Current treatments strive to maintain a high level of efficacy while reducing side effects that limit the quality and length of survival. Sophisticated molecular techniques continue to aid our understanding of the etiology and pathogenesis of this disease. However, the heterogeneity and paucity of "malignant" cells in Hodgkin's disease continue to limit our ability to articulate a coherent and encompassing model.