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 relapsed or refractory classical Hodgkin lymphoma".)
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.
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- 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