Hodgkins lymphoma Hodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow,

and other sites. Causes The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. Patients with HIV infection are more at risk than the general population. Doctors know that most Hodgkin's lymphoma occurs when an infection-fighting cell called a B cell develops a mutation in its DNA. The mutation tells the cells to divide rapidly and to continue living when a healthy cell would die. The mutation causes a large number of oversized, abnormal B cells to accumulate in the lymphatic system, where they crowd out healthy cells and cause the signs and symptoms of Hodgkin's lymphoma. Various types of Hodgkin's lymphoma exist. The type is based on the types of cells involved in your disease and their behavior. Your type determines your treatment options. Classical Hodgkin's lymphoma Classical Hodgkin's lymphoma is the more common type of this disease. It can be broken down further into subtypes. People diagnosed with classical Hodgkin's lymphoma have large, abnormal cells called Reed-Sternberg cells in their lymph nodes. Subtypes of classical Hodgkin's lymphoma include: Nodular sclerosis Hodgkin's lymphoma Mixed cellularity Hodgkin's lymphoma Lymphocyte-depleted Hodgkin's lymphoma Lymphocyte-rich classical Hodgkin's lymphoma Lymphocyte-predominant Hodgkin's lymphoma This much rarer type of Hodgkin's lymphoma involves large, abnormal cells that are sometimes called popcorn cells because of their appearance. Treatment may be different from the classical type. People with this type of Hodgkin's lymphoma may have a better chance of a cure when the disease is diagnosed at an early stage.

Itching all over the body that cannot be explained Loss of appetite Soaking night sweats Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands) Weight loss that cannot be explained as much as 10 percent or more of your body weight Other symptoms that may occur with this disease:

Coughing, chest pains, or breathing problems if there are

swollen lymph nodes in the chest Excessive sweating Pain or feeling of fullness below the ribs due to swollen spleen or liver Pain in lymph nodes after drinking alcohol Skin blushing or flushing Note: Symptoms caused by Hodgkin's lymphoma may also occur also with other conditions. Talk to your doctor about the meaning of your specific symptoms.

Signs and symptoms Patients with Hodgkin's lymphoma may present with the following symptoms:

Lymph nodes: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes, or lymphadenopathy. The nodes may also feel rubbery and swollen when examined. The nodes of the neck and shoulders (cervical and supraclavicular) are most frequently involved (80 90% of the time, on average). The lymph nodes of the chest are often affected, and these may be noticed on a chest radiograph. Itchy skin Night sweats Unexplained weight loss Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma. The enlargement, however, is seldom massive and the size of the spleen may fluctuate during the course of treatment. Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases. Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease. Pain following alcohol consumption: classically, involved nodes are painful after alcohol consumption, though this phenomenon is very uncommon,[12] occurring in only two to three percent of people with Hodgkin's lymphoma,[13] thus having a low specificity. On the other hand, its sensitivity is high enough for it to be regarded as a pathognomonic sign of Hodgkin's lymphoma.[13] The pain typically has an onset within minutes after ingesting alcohol, and is usually felt as coming from the vicinity where there is an involved lymph node.[13] The pain has been described as either sharp and stabbing or dull and aching. [13] Back pain: nonspecific back pain (pain that cannot be localized or its cause determined by examination or scanning techniques) has been reported in some cases of Hodgkin's lymphoma. The lower back is most often affected.[citation needed] Red-coloured patches on the skin, easy bleeding and petechiae due to low platelet count (as a result of bone

Risk Factors

Factors that increase the risk of Hodgkin's lymphoma include: Your age. Hodgkin's lymphoma is most often diagnosed in people between the ages of 15 and 35, as well as those older than 55. A family history of lymphoma. Anyone with a brother or a sister who has Hodgkin's lymphoma or non-Hodgkin's lymphoma has an increased risk of developing Hodgkin's lymphoma. Your sex. Males are slightly more likely to develop Hodgkin's lymphoma. Past Epstein-Barr infection. People who have had illnesses caused by the Epstein-Barr virus, such as infectious mononucleosis, are more likely to develop Hodgkin's lymphoma than are people who haven't had Epstein-Barr infections. A weakened immune system. Having a compromised immune system, such as from HIV/AIDS or from having an organ transplant requiring medications to suppress the immune response, increases the risk of Hodgkin's lymphoma.

Symptoms

Fatigue Fever and chills that come and go

marrow infiltration, increased trapping in the spleen etc. i.e. decreased production, increased removal) Systemic symptoms: about one-third of patients with Hodgkin's disease may also present with systemic symptoms, including lowgrade fever; night sweats; unexplained weight loss of at least 10% of the patient's total body mass in six months or less, itchy skin (pruritus) due to increased levels of eosinophils in the bloodstream; or fatigue (lassitude). Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms; thus, presence of fever, weight loss, and night sweats indicate that the patient's stage is, for example, 2B instead of 2A.[14] Cyclical fever: patients may also present with a cyclical highgrade fever known as the Pel-Ebstein fever,[15] or more simply "PE fever". However, there is debate as to whether or not the P-E fever truly exists.[16]

Hodgkin's cells produce interleukin-21 (IL-21), which was once thought to be exclusive to T cells. This feature may explain the behavior of classical Hodgkin's lymphoma, including clusters of other immune cells gathered around HL cells (infiltrate) in cultures. There are different types of Hodgkin lymphoma. Its grouped using the World Health Organisation (WHO)s lymphoma classification system: Classical typesBack to top These are the most common types of Hodgkin lymphoma. There are four subtypes: Nodular sclerosing Mixed cellularity Lymphocyte-depleted Lymphocyte-rich. Nodular lymphocyte-predominant typeBack to top This is a rare type of Hodgkin lymphoma. About 5% of all Hodgkin lymphomas diagnosed are this type. Each subtype of Hodgkin lymphoma has a particular appearance and characteristic when looked at under a microscope.

Exams and Tests The first sign of Hodgkin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs. The disease may be diagnosed after: Biopsy of suspected tissue, usually a lymph node biopsy Bone marrow biopsy If tests reveal that you do have Hodgkin's lymphoma, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide treatment and follow-up, and gives you some idea of what to expect in the future. The following procedures will usually be done:

Staging The staging is the same for both Hodgkin's as well as non-Hodgkin's lymphomas. After Hodgkin's lymphoma is diagnosed, a patient will be staged: that is, they will undergo a series of tests and procedures that will determine what areas of the body are affected. These procedures may include documentation of their histology, a physical examination, blood tests, chest X-ray radiographs, computed tomography (CT)/Positron emission tomography (PET)/magnetic resonance imaging(MRI) scans of the chest, abdomen and pelvis, and usually a bone marrow biopsy. Positron emission tomography (PET) scan is now used instead of the gallium scan for staging. In the past, a lymphangiogram or surgical laparotomy (which involves opening the abdominal cavity and visually inspecting for tumors) were performed. Lymphangiograms or laparotomies are very rarely performed, having been supplanted by improvements in imaging with the CT scan and PET scan. On the basis of this staging, the patient will be classified according to a staging classification (the Ann Arbor staging classificationscheme is a common one):

Blood chemistry tests including protein levels, liver function

tests, kidney function tests, and uric acid level Bone marrow biopsy CT scans of the chest, abdomen, and pelvis Complete blood count (CBC) to check for anemia and white blood count PET scan Some people may need abdominal surgery to take out a piece of the liver and remove the spleen. However, because the other tests are now so good at detecting the spread of Hodgkin's lymphoma, this surgery is usually not needed. Types Classical Hodgkin's lymphoma (excluding nodular lymphocyte predominant Hodgkin's lymphoma) can be subclassified into 4 pathologic subtypes based upon ReedSternberg cellmorphology and the composition of the reactive cell infiltrate seen in the lymph node biopsy specimen (the cell composition around the ReedSternberg cell(s)). Nodular lymphocyte predominant Hodgkin's lymphoma expresses CD20, and is not currently considered a form of classical Hodgkin's. For the other forms, although the traditional B cell markers (such as CD20) are not expressed on all cells, Reed-Sternberg cells are usually of B cell origin. Although Hodgkin's is now frequently grouped with other B cell malignancies, some T cell markers (such asCD2 and CD4) are occasionally expressed. However, this may be an artifact of the ambiguity inherent in the diagnosis.

Stage I is involvement of a single lymph node region (I) (mostly the cervical region) or single extralymphatic site (Ie); Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe); Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes); Stage IV is disseminated involvement of one or more extralymphatic organs.

The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage. For localized extranodal extension from mass of nodes that

does not advance the stage, subscript 'E' is added. Splenic involvement is signified by adding 'S' to the stage.

Treatment Treatment depends on the following: The type of Hodgkin's lymphoma (most people have classic Hodgkin's) The stage (where the disease has spread) Whether the tumor is more than 4 inches (10 cm) wide Your age and other medical issues Other factors, including weight loss, night sweats, and fever Tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Staging is needed to determine your treatment plan. Stages of Hodgkin's lymphoma range from I to IV. The higher the staging number, the more advanced the cancer. Treatment depends on your age and stage of the cancer.

predominant Hodgkin's lymphoma typically undergo radiation therapy alone. During radiation therapy, you lie on a table and a large machine moves around you, directing the energy beams to specific points on your body. Radiation can be aimed at affected lymph nodes and the nearby area of nodes where the disease might progress. The length of radiation treatment varies, depending on the stage of the disease. Radiation therapy can cause skin redness and hair loss at the site where the radiation is aimed. Many people experience fatigue during radiation therapy. More serious risks include heart disease, stroke, thyroid problems, infertility and other forms of cancer, such as breast or lung cancer. Stem cell transplant A stem cell transplant is a treatment to replace your diseased bone marrow with healthy stem cells that help you grow new bone marrow. A stem cell transplant may be an option if Hodgkin's lymphoma returns despite treatment. During a stem cell transplant, your own blood stem cells are removed, frozen and stored for later use. Next you receive high-dose chemotherapy and radiation therapy to destroy cancerous cells in your body. Finally your stem cells are thawed and injected into your body through your veins. The stem cells help to build healthy bone marrow.

Stages I and II (limited disease) can be treated with radiation

therapy, chemotherapy, or both. Stage III is treated with chemotherapy alone, or a combination of radiation therapy and chemotherapy. Stage IV (extensive disease) is most often treated with chemotherapy alone. People with Hodgkin's lymphoma that returns after treatment or does not respond to the first treatment may receive high-dose chemotherapy. That is followed by an autologous stem cell transplant (using stem cells from yourself). What other treatments you have depend on your symptoms, but may include:

Treatment overviewBack to top The main types of treatment for Hodgkin lymphoma are chemotherapy and radiotherapy. Your doctor will plan your treatment based on the results of the staging tests. They will also take other factors into account when planning your treatment, including: your age your general health (including any other medical conditions you have) your specific type of Hodgkin lymphoma which parts of your body are affected the size of the affected lymph nodes and whether or not the lymphoma involves other organs whether or not you have symptoms such as high temperatures, night sweats or weight loss the results of the blood tests youve had. Your doctor will explain your treatment to you and the reasons why theyve chosen it. People with early-stage Hodgkin lymphoma will usually be given a course of chemotherapy before radiotherapy. When the disease is more widespread, chemotherapy is nearly always the main treatment but you may also be given radiotherapy. If Hodgkin lymphoma doesnt respond well to standard chemotherapy, or comes back, high-dose chemotherapy with stem cell support may be used. Possible long-term effectsBack to top Treatments for Hodgkin lymphoma may occasionally cause serious long-term side effects. Some chemotherapy drugs can cause permanent infertility. This can be distressing to cope with when you are already dealing with the illness and its treatment.

Transfusion of blood products, such as platelets or red blood cells, to fight low platelet counts and anemia Antibiotics to fight infection, especially if a fever occurs Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill lymphoma cells. Chemotherapy drugs travel through your bloodstream and can reach nearly all areas of your body. Chemotherapy is often combined with radiation therapy in people with early-stage classical type Hodgkin's lymphoma. Radiation therapy is typically done after chemotherapy. In advanced Hodgkin's lymphoma, chemotherapy may be used alone or combined with radiation therapy. Chemotherapy drugs can be taken in pill form or through a vein in your arm. Several combinations of chemotherapy drugs are used to treat Hodgkin's lymphoma. Side effects of chemotherapy depend on the specific drugs you're given. Common side effects include nausea and hair loss. Serious long-term complications can occur, such as heart damage, lung damage, fertility problems and other cancers, such as leukemia. Radiation Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. For classical Hodgkin's lymphoma, radiation therapy can be used alone, but it is often used after chemotherapy. People with early-stage lymphocyte-

Chemotherapy and radiotherapy can also lead to a slightly increased risk of developing another cancer later in life. However, current treatments are designed to limit these risks as much as possible. Its important to discuss any concerns you have with your doctors.

Pathology Macroscopy Affected lymph nodes (most often, laterocervical lymph nodes) are enlarged, but their shape is preserved because the capsule is not invaded. Usually, the cut surface is white-grey and uniform; in some histological subtypes (e.g. nodular sclerosis) a nodular aspect may appear. A fibrin ring granuloma may be seen. Microscopy Micrograph showing a "popcorn cell", the Reed-Sternberg cell variant seen in nodular lymphocyte predominant Hodgkin lymphoma.H&E stain. Microscopic examination of the lymph node biopsy reveals complete or partial effacement of the lymph node architecture by scattered large malignant cells known as Reed-Sternberg cells (RSC) (typical and variants) admixed within a reactive cell infiltrate composed of variable proportions of lymphocytes, histiocytes, eosinophils, and plasma cells. The Reed-Sternberg cells are identified as large often bi-nucleated cells with prominent nucleoli and an unusual CD45-, CD30+, CD15+/immunophenotype. In approximately 50% of cases, the ReedSternberg cells are infected by the Epstein-Barr virus. Characteristics of classic Reed-Sternberg cells include large size (20 50 micrometres), abundant, amphophilic, finely granular/homogeneous cytoplasm; two mirror-image nuclei (owl eyes) each with an eosinophilic nucleolus and a thick nuclear membrane (chromatin is distributed close to the nuclear membrane). Variants:

Support Groups You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See: Cancer support group Outlook (Prognosis) Hodgkin's disease is considered one of the most curable forms of cancer, especially if it is diagnosed and treated early. Unlike other cancers, Hodgkin's disease is often very curable, even in its late stages. With the right treatment, more than 90% of people with stage I or II Hodgkin's lymphoma survive for at least 10 years. If the disease has spread, the treatment may be more intense. However, 90% of people with advanced disease survive for at least 5 years. Patients who survive 15 years after treatment are more likely to later die from other causes, including complications of the treatment, rather than from Hodgkin's disease. People with Hodgkin's lymphoma whose disease returns within a year after treatment or who do not respond to the first treatment have a poorer outlook. You will need to have regular exams and imaging tests for years after your treatment. This helps your doctor check for signs of the cancer returning, and for any long-term treatment effects. Possible Complications Treatments for Hodgkin's lymphoma can have complications. Longterm complications of chemotherapy or radiation therapy include:

Heart disease Inability to have children (infertility) Lung problems Other cancers Thyroid problems Chemotherapy can cause low blood cell counts, which can lead to an increased risk of bleeding, infection, and anemia. To reduce bleeding, apply ice and pressure. Use a soft toothbrush and electric razor for personal hygiene. Always take an infection seriously during cancer treatments. Contact your doctor right away if you develop fever or other signs of infection, especially if your white blood cell counts are low due to treatment. Planning rest periods during your daily activities may help prevent fatigue due to anemia. When to Contact a Medical Professional Call your health care provider if:

Hodgkin cell (atypical mononuclear RSC) is a variant of RS cell, which has the same characteristics, but is mononucleated. Lacunar RSC is large, with a single hyperlobated nucleus, multiple, small nucleoli and eosinophilic cytoplasm which is retracted around the nucleus, creating an empty space ("lacunae"). Pleomorphic RSC has multiple irregular nuclei. "Popcorn" RSC (lympho-histiocytic variant) is a small cell, with a very lobulated nucleus, small nucleoli. "Mummy" RSC has a compact nucleus, no nucleolus and basophilic cytoplasm.

Bone marrow diseases (such as leukemia)

Hodgkin's lymphoma can be sub-classified by histological type. The cell histology in Hodgkin's lymphoma is not as important as it is innonHodgkin's lymphoma: the treatment and prognosis in classic Hodgkin's lymphoma usually depends on the stage of disease rather than the histotype. Management Patients with early stage disease (IA or IIA) are effectively treated with radiation therapy or chemotherapy. The choice of treatment depends on the age, sex, bulk and the histological subtype of the disease. Patients with later disease (III, IVA, or IVB) are treated with combination chemotherapy alone. Patients of any stage with a large mass in the chest are usually treated with combined chemotherapy and radiation therapy.

You have symptoms of Hodgkin's lymphoma You have Hodgkin's lymphoma and you have side effects from the treatment

It should be noted that the common non-Hodgkin's treatment, rituximab (which is a monoclonal antibody against CD20) is not routinely used to treat Hodgkin's lymphoma due to the lack of CD20 surface antigens in most cases. The use of rituximab in Hodgkin's lymphoma, including the lymphocyte predominant subtype has been reviewed recently.[20] Although increased age is an adverse risk factor for Hodgkin's lymphoma, in general elderly patients without major comorbidities are sufficiently fit to tolerate standard therapy, and have a treatment outcome comparable to that of younger patients. However, the disease is a different entity in older patients and different considerations enter into treatment decisions.[21] For Hodgkin's lymphomas, radiation oncologists typically use external beam radiation therapy (sometimes shortened to EBRT or XRT). Radiation oncologists deliver external beam radiation therapy to the lymphoma from a machine called a linear accelerator. Patients usually describe treatments as painless and similar to getting an X-ray. Treatments last less than 30 minutes each, every day but Saturday and Sunday. For lymphomas, there are a few different ways radiation oncologists target the cancer cells. Involved field radiation is when the radiation oncologists give radiation only to those parts of the patient's body known to have the cancer. Very often, this is combined with chemotherapy. Radiation therapy directed above the diaphragm to the neck, chest and/or underarms is called mantle field radiation. Radiation to below the diaphragm to the abdomen, spleen and/or pelvis is called inverted-Y field radiation. Total nodal irradiation is when the therapist gives radiation to all the lymph nodes in the body to destroy cells that may have spread.[22] [edit]Adverse effects The high cure rates and long survival of many patients with Hodgkin's lymphoma has led to a high concern with late adverse effects of treatment, including cardiovascular disease and second malignancies such as acute leukemias, lymphomas, and solid tumors within the radiation therapy field. Most patients with early-stage disease are now treated with abbreviated chemotherapy and involved-field radiation therapy rather than with radiation therapy alone. Clinical research strategies are exploring reduction of the duration of chemotherapy and dose and volume of radiation therapy in an attempt to reduce late morbidity and mortality of treatment while maintaining high cure rates. Hospitals are also treating those who respond quickly to chemotherapy with no radiation. In childhood cases of Hodgkin's lymphoma, long-term endocrine adverse effects are a major concern, mainly gonadal dysfunction and growth retardation. Gonadal dysfunction seems to be the most severe endocrine long-term effect, especially after treatment with alkylating agents and/or pelvic radiotherapy.[23] Complications

The lymphatic system is made up of lymphatic organs such as bone marrow, the tonsils, the thymus, the spleen and lymph nodes (sometimes called lymph glands). The lymph nodes throughout the body are connected by a network of tiny lymphatic tubes (ducts). There are lymph nodes in many places in the body but theyre mainly found in the neck, armpit and groin. Their number varies from one part of the body to another, and there are very few in some parts. However, under your arm there may be 20-50 nodes. Circulating the lymphatic vessels is a milky-looking fluid called lymph, which contains lymphocytes. Lymphocytes are white blood cells. They are an essential part of the bodys defence against infection and disease. As it circulates, lymph passes through the lymph nodes, which filter out the bacteria that cause infection. So if you have a sore throat, you may notice that the lymph nodes in your neck get larger. This is a sign that your body is fighting the infection. There are two main types of lymphocyte: T-cells and B-cells. All lymphocytes develop in the bone marrow from immature cells called stem cells. Lymphocytes that mature in the thymus gland (behind the breastbone) are called T-cells. Lymphocytes that mature in the bone marrow or lymphatic organs are called B-cells. The difference between Hodgkin lymphoma and NHL Its only possible to tell the difference between Hodgkin lymphoma and non-Hodgkin lymphoma when the cells are looked at under a microscope. In most cases of Hodgkin lymphoma, a particular cell called the ReedSternberg cell is found when cells from the lymph node are examined during diagnosis. This cell isnt usually found in other types of lymphoma, so these types are called non-Hodgkin lymphoma. This difference is important, because the treatment for Hodgkin and non-Hodgkin lymphoma can be very different. Its thought that ReedSternberg cells are a type of white blood cell - a B-cell that has become cancerous. B-cells normally make antibodies to fight infection. Blood tests Bone marrow sample Chest x-ray CT scan (computerised tomography scan) PET (positron emission tomography) scan PET/CT scan MRI (magnetic resonance imaging) scan Follow-up after treatment for Hodgkin lymphoma After your treatment has finished youll have regular check-ups. To begin with, these may be every three months or so and will include a physical examination, blood tests and possibly chest x-rays. Sometimes a PET scans might be used to check whether all the lymphoma has gone after treatment. Youll usually have one of these scans within the first year. After the first year, routine scans tend not to be used unless you have symptoms. This is because so far research has not shown that they are useful at finding out whether or not the lymphoma has returned before symptoms appear. Your follow-up appointments will gradually become less frequent, but youll probably continue to have them for several years. Many people

Bone metastasisBone metastasis Comprehensive overview covers symptoms and treatment of bone metastasis in people with cancer. Pericardial effusionPericardial effusion Overview covers symptoms, causes and treatment of excess fluid around the heart. The lymphatic system The lymphatic system is one of the bodys natural defences against infection and disease.

find that for a while they get very anxious before the appointments. This is natural. It may help to get support from family, friends or useful organisations during this time. If you have any problems, or notice any new symptoms in between check-ups, let your doctor know as soon as possible.

For people whose treatment is over apart from regular check-ups, our section on adjusting to life after cancer gives useful advice about keeping healthy and adjusting to life after treatment.

Name

Description

ICD10

ICD-O

Nodular sclerosing HL

Is the most common subtype and is composed of large tumor nodules showing scattered lacunar classical RS cells set in a background of reactive lymphocytes, eosinophils and plasma cells with varying degrees of C81.1 M9663/3 collagen fibrosis/sclerosis.

Is a common subtype and is composed of numerous classic RS cells admixed with numerous inflammatory Mixed-cellularity subtype cells including lymphocytes, histiocytes, eosinophils, and plasma cells without sclerosis. This type is most often associated with EBV infection and may be confused with the early, so-called 'cellular' phase of nodular sclerosing CHL. C81.2 M9652/3.

Lymphocyte-rich or Lymphocytic predominance

Is a rare subtype, show many features which may cause diagnostic confusion with nodular lymphocyte predominant B-cell Non-Hodgkin's Lymphoma (B-NHL). This form also has the most favorable prognosis.

C81.0 M9651/3

Lymphocyte depleted

Is a rare subtype, composed of large numbers of often pleomorphic RS cells with only few reactive lymphocytes which may easily be confused with diffuse large cell lymphoma. Many cases previously classified within this category would now be reclassified underanaplastic large cell lymphoma.[7] C81.3 M9653/3

Unspecified

C81.9 M9650/3

ABVD

Stanford V

BEACOPP

Doxorubicin

Doxorubicin

Doxorubicin

Bleomycin

Bleomycin

Bleomycin

Vinblastine

Vinblastine, Vincristine

Vincristine

Dacarbazine

Mechlorethamine

Cyclophosphamide, Procarbazine

Etoposide

Etoposide

Prednisone

Prednisone