الفهرس 
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Abstract
Hodgkin’s lymphoma (HL), formerly called Hodgkin’s disease, is a malignant tumor of the lymphatic system [1]. It was first recorded by Thomas Hodgkin in 1832 [2].
HL is characterized clinically by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. Pathologically, the disease is characterized by the presence of Reed-Sternberg (RS) cells. The most common sign of HL is swollen but painless lymph nodes. HL is a complex of related conditions that are part mediated by infectious diseases, immune deficits and genetic susceptibilities [3].
In the United States, an estimated 8490 new diagnoses of HL and 1320 deaths from the dis¬ease occurred In 2010 [4].
In Mediterranean countries, the highest incidence of HL was in fact recorded in Israel in 2012 with an estimated incidence age-standardized rate (ASR) of 3.71 per 100,000, followed by Lebanon (3.67), Croatia (3.09), France (2.61) and Italy (2.39). The lowest incidence was recorded in Albania with an ASR of 1.1 per 100,000. Other countries with a low HL incidence included Egypt (1.51), Morocco (1.7) and Algeria (1.83) [5].
It has a bimodal age distribution in both sexes, peaking in young adults (aged 15-34 years) and older individuals (>55 years) [6]. HL is the third most common cancer in people aged 15-29 years, and the sixth most commonly diagnosed cancer in children below 14 years [7, 8].
The World health organization (WHO) classification divides HL into 2 main types: classical and nodular lymphocyte-predominant Hodg¬kin lymphoma (CHL and NLPHL, respectively). CHL is divided into 4 subtypes: nodular sclerosis (NS), mixed cellularity (MC), lymphocyte-depleted (LD), and lymphocyte-rich (LR). In western countries, NLPHL accounts for 5% and CHL for 95% of all HL cases [9].
Staging for HL is based on the Ann Arbor staging system. Each stage (I–IV) is subdivided into A and B categories. “A” indicates that no systemic symptoms are pres¬ent, and “B” is assigned to patients with unexplained weight loss of more than 10% of body weight within the preceding 6 months, unex¬plained fever (temperature higher than 38C°), or drenching night sweats [10].
Fine needle aspiration cytology (FNAC) alone is generally insufficient for initial diagnosis. Core needle biopsy may be adequate for diagnosis, but the panel recommends excisional lymph node biopsy [11] .
Positron emission tomography/ Computed tomography (PET/CT) scan¬ning has been used for initial staging, restaging, and follow-up of patients with lymphoma [12].
The past few decades have seen significant prog¬ress in the management of HL; it is now curable in at least 80% of patients. With the advent of more effec¬tive treatment options, national statistics have shown an improvement in the 5-year survival rates of these patients that is unmatched in any other cancer over the past 4 decades. In fact, cure rates for HL have increased so markedly that the overriding treatment considerations often relate to long-term toxicity, especially for patients with early-or intermediate-stage disease [13].
The primary goal of therapy is to induce a complete remission (CR), which is defined as the disappearance of all evidence of disease, as evaluated by PET/CT scanning, physical examination, and bone marrow examination [14].
Patients with clinical stages IA or IIA CHL who do not have unfavorable factors (i.e., bulky disease, elevated ESR, >3 sites of involvement, B symptoms, extra nodal disease) should receive 2-4 cycles of the ABVD regimen or 2cycles of the Stanford V regimen, followed by involved-field radiotherapy (IFRT) [15].