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Overview of Hodgkin lymphoma in children and adolescents

Kenneth L McClain, MD, PhD
Kala Kamdar, MD, MS Epi
Section Editor
Julie R Park, MD
Deputy Editor
Alan G Rosmarin, MD


Hodgkin lymphoma (HL, formerly called Hodgkin's disease) is a malignant lymphoma that accounts for approximately 7 percent of childhood cancers and 1 percent of childhood cancer deaths in the United States (table 1) [1]. The incidence of HL in childhood varies by age such that HL is exceedingly rare in infants, but is the most common childhood cancer in the 15- to 19-year-old age group. Children and adolescents with HL have a five-year survival of 94 percent since 2002 compared with an 81 percent survival in the early 1970s [2].

Few risk factors, other than those related to viral exposure and immune function, have been convincingly identified. (See "The role of Epstein-Barr virus in Hodgkin lymphoma" and "The Reed-Sternberg cell and the pathogenesis of Hodgkin lymphoma".)

This topic will provide an overview of HL in children and adolescents. The pathobiology of HL and its diagnosis and management in adults are presented separately as is the care of the adult survivor of HL. (See "Overview of the approach to the adult survivor of classical Hodgkin lymphoma" and "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults" and "Overview of the treatment of classical Hodgkin lymphoma in adults".)


Variation in the incidence, age, and sex distribution of HL occurs in different populations according to geographic location, socioeconomic status, and immunologic status. In the United States and other economically advantaged countries, two incidence peaks exist: one in young adults and one in persons older than 50 years; most patients are young adults (figure 1) [1,3]. The estimated age-related incidence rates are 29 cases per million per year in adolescents aged 15 to 19; approximately 10 per million per year in 10- to 14-year-olds; 3.5 per million in five- to nine-year-olds; and one per million for ages zero to four years. The bimodal age distribution of HL is different in economically disadvantaged areas. An initial peak occurs in childhood for boys, relatively low rates are found in young adults, and a late peak occurs in older adults [4]. (See "Epidemiology, pathologic features, and diagnosis of classical Hodgkin lymphoma", section on 'Incidence and age distribution'.)

The overall incidence of HL in adolescents is greater in females than in males (male to female ratio 0.8); however, boys under age 15 have higher incidence of HL, with up to fivefold higher incidence of HL in boys than girls less than five years of age [5]. The incidence of HL is similar among white and African American children younger than 10 years of age, but is increased among white children relative to African Americans older than 10 years (ratio of 1.4:1) [5].


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