Hodgkin Lymphoma: Diagnostic and Therapeutic Approach
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Abstract
Hodgkin Lymphoma is a malignant neoplasm derived from B cells, it corresponds to 10% of hematological neoplasms and has the best prognosis among lymphoid malignancies. About 80-90% of Hodgkin Lymphoma can be cured with the first line of treatment. An inflammatory microenvironment with at least 1% neoplastic cells (Reed-Sternberg cells and their variants) is observed in the architecture of the node. Its incidence is estimated at 1 case/100,000/inhabitants per year and a mortality of 0.7 per individuals/100,000 inhabitants per year. It characteristically has a bimodal presentation and has a close relationship with EBV as the etiological agent in 45% of cases. Historically, the AVBD regimen has been considered the standard treatment regimen; however, management with anti-CD30 in the first line may be a therapeutic option. In our review we describe the usefulness of adequate stratification, use of interim-PET to avoid overtreating or undertreating patients, as well as PET-CT at the end of treatment to omit the need for radiotherapy and thereby reduce the risk of chronic toxicities. It is of utmost importance that in the evaluation at the end of treatment in cases of treatment with immunotherapy, consider pseudoprogression based on the LYRYC criteria with the need for PET-Ct 3 months later to consider or rule out pseudoprogression. Historically, the ABVD or BEACOPP Scheme have been the treatment standards, however with immunotherapy with Brentuximab and checkpoint inhibitors such as nivolumab or pembrolizumab either with first-line regimens such as BV + AVD or nivolumab +AVD or pembrolizumab or in Rescue schemes have revolutionized the natural history of Hodgkin's disease, improving disease-free and overall survival, reducing the risk of chronic toxicity presented with traditional schemes.
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