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Hodgkin’s Lymphoma

Hodgkin's Lymphoma

Initially referred to as Hodgkin’s disease, Hodgkin’s lymphoma was named after Dr. Thomas Hodgkin, who made this groundbreaking discovery in 1832 while diagnosing several cases of cancer originating in the lymph nodes. While relatively rare, with approximately 9,000 cases diagnosed each year, Hodgkin’s lymphoma is a form of cancer that primarily affects the lymphatic system, specifically the lymphocytes. Lymphocytes are specialized cells responsible for producing antibodies that play a crucial role in defending the body against foreign invaders like viruses and bacteria. In the case of Hodgkin’s lymphoma, a particular type of mature B-cell becomes cancerous, transforming into Reed-Sternberg cells. These cells exhibit an abnormal growth pattern, characterized by their unusually large size and having more than one nucleus.

Hodgkin Lymphoma in Adults

Types of Hodgkin’s Lymphoma

Classic Hodgkin’s lymphoma is characterized by the presence of both Hodgkin’s and Reed-Sternberg cells and its four subtypes are categorized based on the distinct characteristics and behavior of the cells involved.

  • Nodular Sclerosis Hodgkin’s Lymphoma: Nodular sclerosis accounts for approximately 70% of classic Hodgkin’s lymphoma cases. It primarily affects young adults and is characterized by lymph nodes containing highly fibrous tissue. Nodular sclerosis Hodgkin’s lymphoma is considered highly curable.
  • Mixed Cellularity Hodgkin’s Lymphoma: This type affects about 20-25% of all classic Hodgkin’s lymphoma cases and is more common in children, older patients or individuals with HIV or Epstein-Barr virus (EBV) infections.
  • Lymphocyte-Rich Hodgkin’s Lymphoma: Lymphocyte-rich Hodgkin’s lymphoma is relatively rare, occurring in 5% of classic Hodgkin’s lymphoma cases. In this type, lymph nodes have very few normal cells but abundant Reed-Sternberg cells. It typically affects older patients or those with HIV.
  • Lymphocyte-Depleted Hodgkin’s Lymphoma: This is the rarest type of Hodgkin’s lymphoma and is often diagnosed in the late stages of the disease.

In addition to these classic types of Hodgkin’s lymphoma, there is also a rare subtype known as nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL). NLPHL primarily features lymphocyte-predominant cells, often referred to as “popcorn cells,” which are variants of Reed-Sternberg cells. NLPHL typically affects a small percentage of Hodgkin’s lymphoma patients, specifically those aged between 30 and 50, accounting for about 5% of cases in this age group. Fortunately, NLPHL is associated with a high cure rate and carries minimal risk of progressing into a more aggressive form of non-Hodgkin’s lymphoma.



The initial indication of Hodgkin’s lymphoma often manifests as the noticeable enlargement of one or more lymph nodes, which can occur in various areas of the body, including the neck, upper chest, armpits, abdomen or groin. Remarkably, these swollen lymph nodes are typically painless.

The specific signs and symptoms experienced can provide valuable insights into the nature and stage of the disease, especially in cases related to B-cell abnormalities. These B-cell-related symptoms include:

  • Persistent fever
  • Drenching night sweats
  • Unexplained weight loss: Significant weight loss that cannot be attributed to changes in diet or physical activity
  • Additional symptoms associated with Hodgkin’s lymphoma may include:

    • Ongoing, unexplained fatigue that may be debilitating
    • Cough and shortness of breath, particularly if chest lymph nodes are enlarged, putting pressure on the airways
    • Itchy skin, especially after bathing or alcohol consumption
    • Decreased appetite
    • Abdominal pain or swelling
    • Feeling full, often related to an enlarged spleen

Causes and Risk Factors

Hodgkin’s lymphoma occurs when there is an abnormal change to the DNA of a white blood cell (lymphocyte) resulting in an uncontrollable growth of cancerous lymphocytes. These cancerous lymphocytes outnumber the normal and healthy ones resulting in the body’s inability to protect itself and ward off infections.

For those who have Hodgkin’s lymphoma, the precise underlying cause remains unknown, yet several risk factors have been identified that can increase the chances of developing Hodgkin’s lymphoma:

  • Previously infected with Epstein-Barr virus (EBV) which is known for causing mononucleosis. While many are affected with EBV, very few develop Hodgkin’s lymphoma.
  • Hodgkin’s lymphoma is most prevalent among young adults between 15-29 and older adults between 75-79.
  • Hodgkin’s lymphoma is slightly more common in males.
  • People with already weakened immune systems are more likely to develop Hodgkin’s lymphoma, and those who take immunosuppressants for autoimmune issues are also at a higher risk.


An accurate diagnosis is essential for a patient’s well being as it forms the foundation for an appropriate treatment plan and provides insights into the disease’s progression and subtype. In cases where Hodgkin’s lymphoma (HL) is suspected, it can be a complex condition to diagnose, and seeking a second opinion from an experienced hematopathologist, who specializes in blood and bone marrow disorders, would be a wise step.

The diagnostic process typically begins with your healthcare provider taking a comprehensive medical history and conducting a detailed discussion to understand your symptoms. A thorough physical examination follows, during which your doctor will assess the size of lymph nodes in areas such as the neck, armpits and groin, as well as check the dimensions of your liver and spleen.

Following the initial assessment, a biopsy procedure may be necessary to officially confirm the presence of Hodgkin’s Lymphoma (HL). The most frequently used and recommended biopsy method is an excision biopsy, in which the entire lymph node is surgically removed. This procedure is relatively straightforward and can be performed with a local anesthetic if the lymph node is close to the skin’s surface. However, for lymph nodes located deeper in the body, such as those in the chest or abdomen, sedation may be required.

The biopsy specimen extracted from your lymph nodes will be meticulously examined by a hematopathologist, a specialist in blood disorders, to confirm the diagnosis of HL and identify the specific HL subtype. This critical information will guide the development of a tailored treatment plan that best suits your individual needs and circumstances.


The healthcare providers at Sheba employ state-of-the-art testing to understand the current stage of Hodgkin’s lymphoma with examinations, imaging, blood tests and sometimes bone marrow tests to determine the stage of the disease.

  • Stage I: This stage characterizes the presence of HL cells in a single lymph node region or in an organ situated outside the lymphatic system.
  • Stage II: In this stage, HL cells are found in two or more lymph node regions located either on the same side as the diaphragm, above it, below it or in a lymph node and adjacent organ outside the lymphatic system on the same side of the diaphragm.
  • Stage III: At this stage, HL cells are detected in lymph node regions on both sides of the diaphragm, either above or below it, potentially accompanied by some organ involvement outside the lymphatic system or affecting the spleen.
  • Stage IV: This stage represents the widespread presence of HL cells in organs outside the lymphatic system and their adjacent lymph nodes, or the presence of HL cells in a single organ along with distant lymph nodes.


Although Hodgkin’s lymphoma is characterized as an aggressive cancer with the potential to spread throughout the body, it is essential to understand that it is highly treatable. The treatment process can be challenging, and the body may undergo significant strain depending on the stage and progression of the cancer. However, there is hope, and at Sheba, our multidisciplinary team of cancer specialists collaborates to create tailored treatment programs for Hodgkin’s lymphoma patients, taking into account various factors such as the subtype of the disease, the patient’s age, overall health and other critical considerations.

Based on the specific circumstances and indications, your healthcare provider at Sheba will select from a range of treatment options, including chemotherapy, targeted therapy, radiation therapy and, in certain cases, bone marrow transplant.

Our medical team at Sheba, which comprises oncologists, hematologists, hematopathologists and radiation oncologists, adopts a comprehensive approach to lymphoma treatment. We prioritize not only the effective management of the disease but also your comfort and quality of life throughout treatment. To address the holistic needs of our patients, Sheba offers a wide range of mental health professionals, including social workers and psychologists. Additionally, we provide alternative therapies and nutrition counseling to support your overall wellbeing and ensure a well-rounded approach to care.

At Sheba, we are committed to not only treating Hodgkin’s lymphoma but also supporting you in every aspect of your health, both physically and emotionally, to enhance your overall quality of life during and after treatment.



Prognosis in the context of Hodgkin’s lymphoma (HL) refers to the anticipated course of the disease and the likelihood of recovery or relapse. HL is categorized into three subgroups, each with different prognostic factors:

  • Early-Stage Favorable: This subgroup includes Stage I and II HL cases with no unfavorable risk factors. These cases tend to have a more favorable prognosis.
  • Early-Stage Unfavorable: Early-stage HL (Stage I and II) cases with certain risk factors fall into this subgroup.
    • Bulky disease: The presence of a large mass in the chest or any lymph node larger than 10 cm.
    • Three or more affected lymph nodes.
    • B symptoms: Symptoms such as fever, night sweats and unexplained weight loss.
    • Extranodal disease: When an organ outside the lymphatic system is involved.
    • Erythrocyte sedimentation rate (ESR) of 50 or higher.

Early-stage unfavorable cases may require more aggressive treatment due to these risk factors.

  • Advanced Stage: This subgroup encompasses Stage III and IV HL cases, and the prognosis can vary based on several factors.
    • Gender: Males may have a less favorable prognosis.
    • Age: Individuals over the age of 45 may face a more challenging prognosis.
    • Stage IV: HL in Stage IV is generally associated with a poorer prognosis.
    • Low hemoglobin levels.
    • Low albumin levels.
    • High white blood cell count.
    • Abnormal lymphocyte count (either too low or too high).

The presence or absence of these factors can influence the aggressiveness of the treatment options and the overall prognosis for patients with advanced-stage HL. It’s important to note that advancements in medical research and treatment options have improved the overall prognosis for many individuals with HL. Accurate staging, risk assessment and individualized treatment plans play a crucial role in achieving the best possible outcome for HL patients. Patients should discuss their specific case and prognosis with their healthcare team for personalized guidance and support.

Living with Hodgkin’s lymphoma and receiving treatment can bring about significant physical changes in your body, and these changes can pose considerable challenges. They may not only impact your physical wellbeing but also affect your self-esteem and how you perceive yourself. Moreover, these changes can influence your interactions with others, particularly with close family and friends.

Sharing the Journey: Hodgkin's Lymphoma Patients Open Up About Their Experiences

Navigating the physical and psychological toll living with Hodgkin’s lymphoma is truly trying. International patients benefit from Israel’s advanced drug approval policy, affording them access to cutting edge medications and technologies not available elsewhere. Hearing from patients who experience similar hardships may put these medical obstacles into perspective.

Ayelet Rozenberg’s story offers hope to many cancer patients facing Hodgkin’s lymphoma and it is truly inspiring. At only 21 years old, she had to decide between a lifesaving treatment and her ability to conceive later in life. Determined to find a solution, she turned to Prof. Dror Meirow, Head of Sheba’s Fertility Preservation Center, who suggested ovarian tissue cryopreservation, an experimental treatment only ever conducted on one other woman. After the procedure was done, she completed her very intense chemotherapy treatments and went into remission lasting to this very day. Upon meeting her husband, she returned to Prof. Meirow who transplanted three of the five pieces of her preserved ovarian tissue and became the first woman to have four children with the help of this experimental and innovative medical treatment.

Georgii was one week before a major career change when he received his Hodgkin’s lymphoma diagnosis. With little luck in his homeland, Georgii and his mother decided to make the trip to Israel to receive medical treatment at Sheba Medical Center. Within his first week in Israel, all his medical examinations were complete and was due for four rounds of chemotherapy soon after. Georgii and his parents were astonished to see that all the lumps in his lymph nodes were already gone by the second PET scan. Besides routine exams every couple of months, Georgii leads a very happy and healthy life as a university student.

It’s important to recognize that these challenges are normal responses to a serious medical condition and the rigors of treatment. It’s perfectly okay to seek support and share your feelings with your healthcare team, as well as with your loved ones. Sheba’s holistic approach for your physical and mental health provides you with top-tier 360-degree care and can connect you with mental health experts tailored precisely for your needs.

Sheba’s team of social workers, psychologists and other therapists are ready to support you with their guidance and resources for you and your family to navigate these physical and emotional changes.

Remember that you are not alone in facing these challenges, and there are many avenues for support and assistance to help you cope and adapt to the changes brought about by this condition and its treatment.

Receiving medical treatment in Israel is a fruitful experience, with medical advancements and fully-encompassing mental and physical care given by a multifaceted medical team comprising the brightest minds in the medical field.

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