Hodgkin’s lymphoma

Hodgkin's lymphoma (HL) is a malignant B-cell lymphoma. The incidence is 2.2 - 2.7 cases per 100,000 population. Young people from 20 to 35 years old are predominantly affected. The etiology of the disease is not entirely clear, it is possible that the Epstein-Barr virus has an etiological and pathogenetic significance in the development of a tumor. A great contribution to the study of the HL was made by T. Hodgkin, K. Sternberg, D. Reid and S.E. Berezovsky. Hodgkin's lymphoma cells have a unique immunophenotype. It is characterized by the absence of B-cell markers and the presence of CD30. HL has a unique histological and cellular structure: tumor cells account no more than 2%. The rest of the tumor mass is represented by a benign microenvironment. Lymphoma cells are characterized by chromosomal aberrations at the 9p24.1 locus and overexpression of genes contained in this region, including PD-L1, PD-L2, and JAK2. These features have led to the new direction in the treatment of Hodgkin's lymphoma: immunotherapy. The clinical picture is characterized by an increase in various groups of lymph nodes, B-symptoms are often observed. HL is a chemosensitive tumor. As a result of first-line therapy (ABVD or BEACOPP chemotherapy regimens), it is possible to cure up to 85-90% of patients with local stages and up to 65-70% with advanced stages of lymphoma. Escalation or de-escalation PET-adapted strategy can reduce the toxicity of chemotherapy regimens. At relapses, good results (50% of long-term remissions) can be achieved with the help of reserve platinum-containing regimens followed by autologous hematopoietic stem cell transplantation (autoHSCT). In recent years, a targeted drug (immunoconjugate brentuximab vedotin) or immune checkpoints inhibitors (CPI) have been actively introduced into the first and second line of therapy, which has reduced toxicity and improved the effectiveness of therapy. In patients at high risk of relapse, maintenance therapy with brentuximab vedotin is performed. Relapses after autoHSCT may benefit from immunotherapy: CPI or alloHSCT. It should be remembered that CPI should be used with caution, as they can cause autoimmune complications, and after alloHSCT, induce a graft-versus-host reaction. Thus, there is currently a large arsenal of chemotherapeutic, targeted and immune options for the treatment of HL. This lymphoma has become curable for most patients.