Monitoring of the patient with classical Hodgkin lymphoma during and after treatment
- Peter M Mauch, MD
Peter M Mauch, MD
- Professor of Radiation Oncology
- Harvard Medical School
- Jonathan W Friedberg, MD
Jonathan W Friedberg, MD
- Professor of Medicine
- James P Wilmot Cancer Center, University of Rochester
Patients with Hodgkin lymphoma (HL, formerly called Hodgkin's disease) are evaluated at the time of initial presentation to determine the stage of the disease, which is then used to determine whether the patient will be treated with radiotherapy, chemotherapy, or both. Patients are then re-evaluated at regular intervals during and after treatment to assess the response and detect possible recurrence. (See "Staging and prognosis of Hodgkin lymphoma" and "Overview of the treatment of classical Hodgkin lymphoma in adults".)
The recommended approach to monitoring during and after therapy for HL will be reviewed here. The treatment of patients who develop recurrent disease depends upon their initial therapy. These issues are discussed separately. (See "Treatment of relapse of classical Hodgkin lymphoma after initial chemotherapy".)
The patient evaluation after individual treatment cycles consists of a history and physical examination, laboratory studies, and imaging studies.
History — The history should be directed toward the presence or absence of B symptoms (fever, weight loss, and night sweats) or treatment-related toxicity. (See "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults", section on 'Clinical presentation'.) Performance status should be recorded after each treatment cycle. (See "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults".)
Physical examination — The physical examination should document both the reduction in size of previous sites of lymphadenopathy and the continued absence of involvement of previously unaffected sites. This is particularly important with cyclical chemotherapy, which may be discontinued or changed if the patient fails to show objective evidence of response.
- Hagemeister FB, Purugganan R, Podoloff DA, et al. The gallium scan predicts relapse in patients with Hodgkin's disease treated with combined modality therapy. Ann Oncol 1994; 5 Suppl 2:59.
- Hutchings M, Mikhaeel NG, Fields PA, et al. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol 2005; 16:1160.
- Hutchings M, Loft A, Hansen M, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 2006; 107:52.
- Kostakoglu L, Goldsmith SJ, Leonard JP, et al. FDG-PET after 1 cycle of therapy predicts outcome in diffuse large cell lymphoma and classic Hodgkin disease. Cancer 2006; 107:2678.
- Schot BW, Zijlstra JM, Sluiter WJ, et al. Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma. Blood 2007; 109:486.
- Gallamini A, Hutchings M, Rigacci L, et al. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 2007; 25:3746.
- Terasawa T, Lau J, Bardet S, et al. Fluorine-18-fluorodeoxyglucose positron emission tomography for interim response assessment of advanced-stage Hodgkin's lymphoma and diffuse large B-cell lymphoma: a systematic review. J Clin Oncol 2009; 27:1906.
- Raemaekers JM, André MP, Federico M, et al. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol 2014; 32:1188.
- Radford J, Illidge T, Counsell N, et al. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med 2015; 372:1598.
- Advani R, Maeda L, Lavori P, et al. Impact of positive positron emission tomography on prediction of freedom from progression after Stanford V chemotherapy in Hodgkin's disease. J Clin Oncol 2007; 25:3902.
- Friedman S, Henry-Amar M, Cosset JM, et al. Evolution of erythrocyte sedimentation rate as predictor of early relapse in posttherapy early-stage Hodgkin's disease. J Clin Oncol 1988; 6:596.
- Henry-Amar M, Friedman S, Hayat M, et al. Erythrocyte sedimentation rate predicts early relapse and survival in early-stage Hodgkin disease. The EORTC Lymphoma Cooperative Group. Ann Intern Med 1991; 114:361.
- Juweid ME. Utility of positron emission tomography (PET) scanning in managing patients with Hodgkin lymphoma. Hematology Am Soc Hematol Educ Program 2006; :259.
- Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007; 25:579.
- Jerusalem G, Beguin Y, Fassotte MF, et al. Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin's disease and non-Hodgkin's lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 1999; 94:429.
- Hoh CK, Glaspy J, Rosen P, et al. Whole-body FDG-PET imaging for staging of Hodgkin's disease and lymphoma. J Nucl Med 1997; 38:343.
- Devizzi L, Maffioli L, Bonfante V, et al. Comparison of gallium scan, computed tomography, and magnetic resonance in patients with mediastinal Hodgkin's disease. Ann Oncol 1997; 8 Suppl 1:53.
- Jochelson M, Mauch P, Balikian J, et al. The significance of the residual mediastinal mass in treated Hodgkin's disease. J Clin Oncol 1985; 3:637.
- Salloum E, Brandt DS, Caride VJ, et al. Gallium scans in the management of patients with Hodgkin's disease: a study of 101 patients. J Clin Oncol 1997; 15:518.
- Front D, Bar-Shalom R, Israel O. The continuing clinical role of gallium 67 scintigraphy in the age of receptor imaging. Semin Nucl Med 1997; 27:68.
- Gasparini MD, Balzarini L, Castellani MR, et al. Current role of gallium scan and magnetic resonance imaging in the management of mediastinal Hodgkin lymphoma. Cancer 1993; 72:577.
- Spaepen K, Stroobants S, Dupont P, et al. Can positron emission tomography with [(18)F]-fluorodeoxyglucose after first-line treatment distinguish Hodgkin's disease patients who need additional therapy from others in whom additional therapy would mean avoidable toxicity? Br J Haematol 2001; 115:272.
- Hueltenschmidt B, Sautter-Bihl ML, Lang O, et al. Whole body positron emission tomography in the treatment of Hodgkin disease. Cancer 2001; 91:302.
- Guay C, Lépine M, Verreault J, Bénard F. Prognostic value of PET using 18F-FDG in Hodgkin's disease for posttreatment evaluation. J Nucl Med 2003; 44:1225.
- Weihrauch MR, Re D, Scheidhauer K, et al. Thoracic positron emission tomography using 18F-fluorodeoxyglucose for the evaluation of residual mediastinal Hodgkin disease. Blood 2001; 98:2930.
- Naumann R, Vaic A, Beuthien-Baumann B, et al. Prognostic value of positron emission tomography in the evaluation of post-treatment residual mass in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Br J Haematol 2001; 115:793.
- Zinzani PL, Stefoni V, Tani M, et al. Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol 2009; 27:1781.
- Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol 2007; 25:571.
- Kobe C, Dietlein M, Fuchs M. Interpretation and validation of interim positron emission tomography in Hodgkin lymphoma. Leuk Lymphoma 2010; 51:552.
- Kobe C, Kuhnert G, Kahraman D, et al. Assessment of tumor size reduction improves outcome prediction of positron emission tomography/computed tomography after chemotherapy in advanced-stage Hodgkin lymphoma. J Clin Oncol 2014; 32:1776.
- Fallanca F, Giovacchini G, Ponzoni M, et al. Cervical thymic hyperplasia after chemotherapy in an adult patient with Hodgkin lymphoma: a potential cause of false-positivity on [18F]FDG PET/CT scanning. Br J Haematol 2008; 140:477.
- Nyman R, Forsgren G, Glimelius B. Long-term follow-up of residual mediastinal masses in treated Hodgkin's disease using MR imaging. Acta Radiol 1996; 37:323.
- Radford JA, Cowan RA, Flanagan M, et al. The significance of residual mediastinal abnormality on the chest radiograph following treatment for Hodgkin's disease. J Clin Oncol 1988; 6:940.
- DURING TREATMENT
- Physical examination
- Laboratory studies
- Radiologic studies
- Monitoring for chemotherapy-specific toxicities
- - Neuropathy
- - Pneumonitis
- AFTER TREATMENT
- Imaging studies
- - PET/CT scan
- - Computed tomography
- - MRI
- Bone marrow biopsy
- Tissue biopsy
- RESPONSE CATEGORIES
- Complete remission
- Partial remission
- Stable disease
- Progressive disease or relapse after CR
- LONG-TERM FOLLOW-UP
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS