Hodgkin's lymphoma in children

Summarize

1. General

● OVERVIEW: Hodgkin's lymphoma is a malignant tumor of the lymphohematopoietic system and is the most common tumor among adolescents aged 15-19 years.

● Manifestations: enlarged lymph nodes, mediastinal mass and systemic symptoms.

● Treatment: chemotherapy combined with low-dose radiotherapy.

● Prognosis: Good prognosis, with a 5-year survival rate of over 90% for early-stage lesions and a cure rate of over 85% for high-risk lesions.

2. Definition of disease

Hodgkin lymphoma (HL) is a malignant tumor of the lymphohematopoietic system, with primary tumors originating in one or a group of lymph nodes and gradually spreading to adjacent lymph nodes and tissues.

The

Epidemiological

epidemiological

Hodgkin's lymphoma accounts for approximately 4.8%-7% of malignant tumors in childhood and 15%-20% of childhood lymphomas.

Hodgkin's lymphoma occurs most often in adolescents aged 15-19 years. Epidemiologic data in the United States show that Hodgkin's lymphoma is the third most common tumor in children and adolescents under 20 years of age, with an incidence rate of 12.1 per million; it is the most common tumor in adolescents 15-19 years of age, with an incidence rate of 29 per million; and the incidence rates in different childhood age groups are as follows: 0-4 years of age with an incidence rate of 1 per million, 5-9 years of age with an incidence rate of 3.5 per million, and 10-14 years of age with an incidence rate of 10 per million. The incidence rate in different age groups of children is as follows: 0-4 years old - 1 per million, 5-9 years old - 3.5 per million and 10-14 years old - 10 per million.

In adolescents, the overall incidence of Hodgkin's lymphoma is higher in females than in males, with a male to female ratio of 0.8. However, among those under 15 years of age, the incidence is higher in boys than in girls, and is five times higher in boys than in girls under 5 years of age

Etiolog & Risk factors

1. General

The cause of Hodgkin's lymphoma is currently unknown and may be related to Epstein-Barr virus (EBV) infection, immunodeficiency, and genetic factors.

2. Underlying causes

The cause of Hodgkin's lymphoma in children is still unclear. It has been found that classical Hodgkin's lymphoma may be associated with an amplification of the p24.1 fragment on chromosome 9, which causes an increase in the number of copies of the PDL1 (programmed death-1 ligand) and PDL2 (programmed death-2 ligand) genes, thereby overexpressing both PDL1 and PDL2 proteins. This increases the number of copies of the PDL1 and PDL2 genes, which overexpress the PDL1 and PDL2 proteins and activate a signaling pathway called "PD-1-PDL1/L2". The activation of this pathway allows the tumor cells to more easily escape the monitoring and killing by the immune cells and thus proliferate uncontrollably.

3. Risk factors

Risk factors that may increase the risk of developing Hodgkin's lymphoma are EBV infection, immunodeficiency, and a family history of Hodgkin's lymphoma.

EBV infection is associated with Hodgkin's lymphoma, can be detected in Hodgkin's lymphoma Reed-Sternberg cells, and EBV is thought to play a role in the pathogenesis of Hodgkin's lymphoma. The proportion of EBV positivity varies among different histologic subtypes. 25-50% of cases of classical Hodgkin's lymphoma in developed countries are EBV-positive.

People with immunodeficiencies also have an increased risk of developing Hodgkin's lymphoma. People with autoimmune lymphoid hyperplasia have 50 times the risk of developing Hodgkin's lymphoma. The risk of Hodgkin's lymphoma is also increased in people with HIV and in children and adolescents who have received solid organ transplants. Hodgkin's lymphoma is the second most common secondary malignancy in the group of children who receive solid organ transplants.

Family-associated Hodgkin's lymphoma accounts for 4.5% of all Hodgkin's lymphoma cases. If a sibling or parent in a family has Hodgkin's lymphoma, that family member's risk of developing the disease is 3.3 times higher than that of the general population. The increased risk of familial association with the disease may result from shared environmental factors, viral exposure, and genetic influences.

Classification & Stage

Type of disease

1) Disease typing

According to the World Health Organization (WHO) classification of lymphomas, Hodgkin's lymphoma can be divided into classical Hodgkin's lymphoma and nodular lymphocyte-dominant lymphoma. The treatment and prognosis of these two types differ.

:: Classic Hodgkin's lymphoma

Classic Hodgkin's lymphoma accounts for 90-95% of Hodgkin's lymphomas and can be subdivided into four subtypes:

● Nodular sclerosis (NS): this subtype accounts for 80% of Hodgkin's lymphoma cases in older children and adolescents and 55% of Hodgkin's lymphoma cases in younger children.

Mixed cellularity (MC): This subtype is common in young children and is easily confused with non-Hodgkin's lymphoma. According to U.S. statistics, this subtype accounts for 20% of Hodgkin's lymphomas in children under 10 years of age and 9% in children and adolescents over 10 years of age.

● Lymphocyte depleted (LD): this subtype is rare in children and is common in HIV-infected adult Hodgkin's lymphoma patients.

● Lymphocyte rich (LR): this subtype is rare in children.

● nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)

This type of Hodgkin's lymphoma accounts for 5-10% of all pediatric Hodgkin's lymphoma cases, and is more common in children under 10 years of age than in children 10-19 years of age. Tumor cells in nodular lymphocyte-dominant Hodgkin lymphoma have distinct pathologic features that distinguish them from tumor cells in classic Hodgkin lymphoma. Patients with nodular lymphocyte-dominant lymphoma usually have a better prognosis than those with classic Hodgkin's lymphoma.

2) Disease Staging

Clinical staging of Hodgkin's lymphoma in children and adolescents is consistent with adult Hodgkin's lymphoma and follows the Hodgkin's lymphoma 2014 Lugano staging criteria:

● Stage I: Invasion of a single lymph node area or lymphoid structure such as the spleen, thyroid, Ring of Weiss, etc. or other extra-nodal organs/sites (IE).

● Stage II: On the diaphragmatic side, invasion of two or more lymph node areas, or plus limited invasion of 1 extranodal organ/site (IIE).

● Stage III: invaded lymph node areas on both sides of the diaphragm (III) or plus limited invasion of 1 extranodal organ/site (IIIE) or spleen (IIIS) or both (IIISE).

● Stage III1: with or without splenic hilar, abdominal or hilar region lymph node involvement.

● Stage III2: There is para-aortic, iliac, and mesenteric lymph node involvement.

● Stage IV: Diffuse or disseminated invasion of 1 or more extranodal organs with or without lymph node involvement.

Stages of Hodgkin's lymphoma are also often used in conjunction with the following letters to convey a specific meaning:

● A: Asymptomatic;

● B: Fever (temperature over 38°C), night sweats, unexplained weight loss of 10% or more within 6 months;

● E: Involvement of a single extranodal site, with lesions involving lymph nodes/lymphoid tissues directly connected to or adjacent to the organ/tissue;

● S: Spleen involvement.

3) Disease grouping

Different clinical collaborative groups for pediatric Hodgkin's lymphoma use different risk groupings. The Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Childhood and Adolescent Lymphomas 2020 refer to the American Children's Oncology Collaborative Group's (COG) AHOD0431 clinical study, which grouped pediatric and adolescent Hodgkin's lymphomas as follows:

● Low-risk: Stage IA or IIA without a large mass.

● Intermediate risk: stage IB or IIB lesions; stage IA or IIA with a large mass; stage IAE or IIAE, stage IIIA or IVA lesions with or without a large mass.

● High risk: stage IIIB or IVB lesions.

A "large mass" was defined as follows: a large peripheral lymph node mass was defined as a single or multiple intermingled lymph nodes with a diameter greater than 6 cm; a large mediastinal mass was defined as a CT-indicated mediastinal tumor with a diameter of 10 cm or greater, or greater than 1/3 of the internal diameter of the thorax.

Clinical manifestations

1. General

Signs and symptoms of Hodgkin's lymphoma in children and adolescents include enlarged lymph nodes, mediastinal masses, and systemic symptoms.90% of Hodgkin's lymphomas present with enlarged lymph nodes as the first symptom.80-85% of children present with lymph node and/or splenic involvement only (Stages I-III), and 15%-20% of patients have liver, lung, or bone marrow involvement (Stage IV). The majority of Hodgkin's lymphomas occur above the septum, with only about 3% of cases occurring below the diaphragm.

2. Symptoms and signs

●Enlarged lymph nodes: 80% of children with Hodgkin's lymphoma present with painless enlarged lymph nodes, usually involving the neck, clavicle, and axillary lymph nodes, and less frequently the inguinal lymph nodes. The involved lymph nodes are usually rubbery, nontender, and harder than inflammatory lymph node enlargement.

● Mediastinal mass: 75% of children with Hodgkin's lymphoma have a mediastinal mass detected on chest radiographs at the time of presentation. Mediastinal masses are more common in children over the age of 12 years, and about 30% of these children have masses that are more than 1/3 the diameter of the inner chest diameter. This large mediastinal lesion can cause dysphagia, dyspnea, cough, wheezing, or superior vena cava syndrome. A small percentage of children with intrathoracic lesions will present with hypertrophic osteoarthropathy, which is clinically characterized by painful periosteal hyperplasia of the pestle and tube bones.

● Lymphoma group B symptoms (i.e., those represented by the letter B in the staging): Lymphoma group B symptoms are a group of prognostically relevant systemic symptoms, including unexplained fever (sublingual temperature >38.0°C), weight loss (≧10% loss in the 6 months prior to diagnosis), and night sweats.

● Other symptoms: malaise, anorexia, etc. Patients with advanced Hodgkin's lymphoma may develop hepatosplenomegaly. In a few rare cases, patients may develop autoimmune disorders such as autoimmune hemolytic anemia, thrombocytopenia, or neutropenia.

Clinical Department

1. General

The primary diagnosis of Hodgkin's lymphoma in children is based on clinical presentation, physical examination, laboratory tests, imaging, and histopathology.

2. Consultation room

Pediatric Hematology-Oncology, Pediatric Oncology, Oncology, Hematology, etc.

Examination & Diagnosis

1. Diagnostic basis

Histopathologic findings are the "gold standard" for diagnosing childhood Hodgkin's lymphoma. Histopathologic samples of childhood Hodgkin's lymphoma usually contain characteristic giant multinucleated cells (called Reed-Sternberg cells) or mononuclear variants of these cells.

2. Relevant inspections

1) History and Physical Examination

Gathering a complete medical history of a patient with suspected Hodgkin's lymphoma requires focusing on: systemic symptoms (e.g., fever, night sweats, weight loss, etc.), history of previous infections, household toxic exposures, and parental occupational hazards, as well as underlying immunodeficiencies and familial cancers (including Hodgkin's lymphoma).

A thorough physical examination includes assessment of general health, measurement of height and weight, determination of size and location of enlarged lymph nodes, liver and spleen size, skin infiltrates, pulmonary manifestations, and neurologic signs. The physical examination must include an examination of the tonsils, root of the tongue, and nasopharynx.

2) Imaging

The purpose of imaging is to determine the extent of the lesion and to guide tissue biopsy, which may include:

PET-CT: PET-CT is more sensitive in detecting nodular and diffuse lesions, and is also more sensitive than bone marrow biopsy for detecting bone marrow involvement, which is important for diagnosis and staging of Hodgkin's lymphoma in children and adolescents.

Cervical/thoracic/abdominal/pelvic enhancement CT or magnetic resonance imaging (MRI): Enhancement CT or MRI provides information about lesions outside the lymph nodes, and the most common sites where extra-nodal lesions are seen are the lung parenchyma, chest wall, pleura, and pericardium.

Chest radiographs (anteroposterior and lateral): provide information about the structure of the chest, the extent of mediastinal involvement, and airway patency.

The child may also require an electrocardiogram and cardiac ultrasound to understand the functioning of his or her heart

3) Histopathological examination

The definitive diagnosis of Hodgkin's lymphoma is made by histopathologic examination, which involves the examination of larger whole lymph nodes or masses cut from diseased lymph nodes or extranodal lesions.

For patients in advanced stages (stages III and IV) with lymphoma group B symptoms or abnormal complete blood counts suggestive of bone marrow involvement, a bone marrow aspiration is recommended to clarify staging.

In addition to being used to confirm the diagnosis of Hodgkin's lymphoma, histopathologic testing can be used to initially stage the disease.

4) Laboratory tests

Routine laboratory tests are required, including: complete blood count, white blood cell count, platelet count, erythrocyte sedimentation rate, liver and kidney function, lactate dehydrogenase, and routine urinalysis. These tests are used to determine the presence of organ involvement and the tendency to relapse after conventional treatment. The child is also examined for infectious diseases such as hepatitis and AIDS.

Detailed immunologic evaluation is recommended for patients with recurrent infections, a past history of autoimmune inflammatory diseases, age of onset less than 5 years, or a family history of immunodeficiency.

5. Differential diagnosis

In children and adolescents, symptoms suspected to be Hodgkin's lymphoma may also be the result of other diseases such as non-Hodgkin's lymphoma, metastatic lymph node enlargement from other primary tumors (e.g., nasopharyngeal carcinoma, soft-tissue sarcoma), toxoplasmosis, typical and atypical mycobacterial infections, EBV infections, systemic lupus erythematosus, infectious mononucleosis, lymphadenopathy, lymph node infection, Castleman's disease etc., which need to be differentiated.

Hodgkin's lymphoma involving the mediastinum needs to be differentiated from mediastinal T-lymphoblastoid lymphoma, neuroblastoma, thymoma, thymoma, embryonal tumors, and mediastinal metastases from other tumors.

Clinical Management

1. General

The mainstay of treatment for Hodgkin's lymphoma is chemotherapy combined with radiation therapy. Treatment options for pediatric and adolescent Hodgkin lymphoma patients differ significantly from those for adult patients in terms of chemotherapy regimen and dose design. Most children's oncology centers treat children and adolescents with Hodgkin's lymphoma using chemotherapy combined with low-dose radiation therapy to the involved area.

2. Chemotherapy

1) Chemotherapy regimen

i) Chemotherapy for children and adolescents with classic Hodgkin's lymphoma

Chemotherapy in the low-risk group is usually a 3-course AV-PC regimen (doxorubicin, vincristine-prednisone, and cyclophosphamide), an ABVD regimen (doxorubicin, bleomycin, vincristine, and dacarbazine), or a 4-course VAMP regimen (vincristine, doxorubicin, methotrexate, and prednisone).

Chemotherapy in the intermediate-risk group is usually a 4-course ABVE-PC regimen (doxorubicin, bleomycin, vincristine, etoposide-prednisone, and cyclophosphamide) or a 6-course COPP/ABV regimen (cyclophosphamide, vincristine, propecia tibialis, prednisone/doxorubicin, bleomycin, and vincristine). A 6-course ABVD regimen is also available.

High-risk group requires high-intensity chemotherapy. The initial is usually a 2-course ABVE-PC regimen, which is evaluated at the end of chemotherapy. If the tumor responds quickly to chemotherapy, then 2 courses of ABVE-PC with radiation are followed; if the response is slow, then 2 courses of isocyclophosphamide + vincristine chemotherapy are followed by 2 courses of ABVE-PC with radiation.

In addition to the above protocols, other collaborative groups' treatment protocols may also be consulted.

For example, the German GPOH-HD95 study used different chemotherapy regimens for boys and girls: the OEPA-COPDAC regimen (vincristine, etoposide, prednisone, doxorubicin-cyclophosphamide, vincristine, prednisone, and dacarbazine) for boys, and the OPPA-COPP regimen for girls (vincristine, procarbazine, prednisone doxorubicin-cyclophosphamide, vincristine, procarbazine, prednisone).

ii) Chemotherapy for nodal lymphocyte-predominant Hodgkin's lymphoma in children and adolescents

The regimens for the intermediate-risk and high-risk groups of nodular lymphocyte-predominant Hodgkin's lymphoma are the same as for classic Hodgkin's lymphoma. The regimens for the low-risk group are usually 3-6 courses of AV-PC regimen, COPP/ABV regimen, or VAMP regimen.

Alternatively, complete resection followed by observation only or chemotherapy with a CVP regimen (cyclophosphamide, vincristine, and prednisone) is possible, but this regimen is not as highly recommended as the above given the current rigor of the evidence from relevant studies.

2) Adverse Reactions

Chemotherapy may cause nausea and vomiting, which can be treated with anti-emetic medication given by your doctor.

The most common acute toxic effect of multidrug chemotherapy is myelosuppression, which means that the three components of the child's blood - white blood cells, red blood cells, and platelets - may be reduced from normal values. This can be treated by infusion of granulocyte colony-stimulating factor (commonly known as "white blood cell boosters") and blood transfusions.

Since the child's immune system function is reduced (possibly as a result of the disease and further impaired by bone marrow suppression), he or she will be more susceptible to infectious diseases such as shingles and chickenpox. Therefore, precautions can be taken to avoid varicella infection in children who were not immunized against varicella prior to chemotherapy. For patients who develop varicella infection or varicella-zoster infection, immediate antiviral therapy should be administered.

3. Radiation therapy

1) Radiotherapy program

Radiotherapy for Hodgkin's lymphoma in children and adolescents is usually low-dose radiotherapy to the area of involvement.

The need for radiotherapy in the low-risk group with classical Hodgkin's lymphoma is inconclusive; in the intermediate-risk group, if radiotherapy is not given, studies have shown that it does not affect overall survival, but event-free survival is lower than in children who receive radiotherapy. Therefore, the need for radiotherapy in the low-risk and intermediate-risk groups is generally determined by the specific condition. Children in the high-risk group require radiotherapy.

For nodular lymphocyte-dominant Hodgkin's lymphoma, in the low-risk group, the need for radiotherapy may be determined on the basis of the specific disease when chemotherapy is used with the COPP/ABV regimen; in the rest of the low-risk group, the chemotherapy regimen is generally not used in conjunction with radiotherapy. The need for radiotherapy in the intermediate-risk group is generally determined by the specific condition. Children in the high-risk group require radiotherapy.

2) Adverse Reactions

Low-dose radiotherapy used for the treatment of pediatric Hodgkin's lymphoma is usually well tolerated, and adverse effects include erythema and/or hyperpigmentation of the irradiated skin, transient thinning of hair in the exposed field, mild gastrointestinal symptoms, dry mouth or altered taste, granulocytopenia, and thrombocytopenia. These symptoms generally subside spontaneously at the end of radiotherapy.

Children who have undergone splenectomy or splenic irradiation are at particular risk of acquiring serious bacterial infections and should receive antibiotic therapy during febrile illness to prevent sepsis in nonsplenic patients.

4. Other treatments

For some cases of relapsed refractory Hodgkin's lymphoma, salvage chemotherapy + high-dose chemotherapy combined with autologous stem cell transplantation may be considered.

5. Cutting-edge therapies

Targeted therapies and immunotherapies for Hodgkin's lymphoma are currently being investigated internationally, and therapies such as vebutuximab, nabulizumab (O-drug), and pabolizumab (K-drug) are being studied for the treatment of Hodgkin's lymphoma in clinical research.

Prognosis

1. General

The majority of pediatric and adolescent Hodgkin's lymphoma patients who receive standardized treatment have an excellent prognosis. The overall 5-year survival rate for early-stage lesions exceeds 90%, and the cure rate for high-risk lesions exceeds 85%.

In general, the prognosis of children with higher stage, presence of lymphoma group B symptoms at diagnosis, and presence of large mass lesions was relatively poor. Other features affecting prognosis were a large mediastinal mass, leukocytosis (white blood cell count over 13,500/μL) at diagnosis, anemia (hemoglobin less than 11 g/dL) at diagnosis, and the child being male.

2. Sequelae

Long-term survivors of childhood Hodgkin's lymphoma may have to deal with a range of long-term side effects including: impaired soft tissue and bone growth, thyroid dysfunction, gonadal dysfunction, cardiopulmonary toxicity, second malignancy, and functional impairment.

1) Impaired soft tissue and bone growth

The dose and target selection of radiotherapy affects bone and soft tissue growth in children. High-dose radiotherapy may cause narrowing of the roof of the chest and soft tissue atrophy in the neck.

2) Thyroid dysfunction

Thyroid dysfunction, usually hypothyroidism, often occurs in children who have received radiation to the head and neck. Thyroid dysfunction occurs 1-10 years after radiotherapy, and this risk is likely to be lifelong. Therefore, children surviving Hodgkin's lymphoma should be screened annually for free T4 and thyroid stimulating hormone, and symptomatic patients should be evaluated early.

3) Gonadal dysfunction

Pelvic radiotherapy may cause loss of ovarian function, which can be preserved by moving the ovaries out of the radiation field with ovarian immobilization. The testes are sensitive to radiotherapy and chemotherapy. Therefore, sperm banking is recommended for children with advanced Hodgkin's lymphoma after puberty. Children treated before puberty should be examined annually to determine whether pubertal status and growth rate are consistent with the patient's age and height. Children with delayed or arrested pubertal growth should have relevant hormone levels measured and treatment tailored to the specific condition.

4) Cardiopulmonary and cardiovascular diseases

Long-term cardiopulmonary and cardiovascular complications of Hodgkin's lymphoma treatment in children include cardiomyopathy, functional valve damage, conduction defects, pericarditis, pulmonary fibrosis, and accelerated atherosclerosis.Patients who have received radiotherapy before the age of 20 years are at the highest risk for cardiovascular complications. Reducing anthracycline chemotherapy doses and radiotherapy doses may reduce the risk of cardiotoxicity. Chronic pulmonary complications of Hodgkin lymphoma treatment in children include pulmonary fibrosis and spontaneous pneumothorax.

Patients need to have an electrocardiogram, echocardiogram, and pulmonary function tests every 1-2 years for the first 5 years after treatment, and then every 3-5 years thereafter if there are no abnormalities.

5) Secondary tumors

Survivors of childhood Hodgkin's lymphoma and soft tissue sarcoma have a somewhat higher incidence of secondary tumors than survivors of other categories of childhood tumors. Children with Hodgkin's lymphoma had 18.5 times the risk of developing secondary tumors, with 10.6% developing secondary tumors 10 years after the end of treatment and 26.3% developing secondary tumors 30 years after the end of treatment.

Some of the more common secondary tumors that develop in childhood Hodgkin lymphoma survivors are breast cancer, thyroid cancer, acute myeloid leukemia, and soft tissue sarcoma. Of these, the incidence of breast cancer is directly related to the dose of radiotherapy. Drugs such as alkylating agents, anthracyclines and etoposide are associated with the risk of treatment-related acute myeloid leukemia.

3. Recurrence

Most pediatric Hodgkin's lymphomas are cured with standard treatment, but 10-20% of children still progress or relapse. Recurrent Hodgkin's lymphoma is defined as the reappearance of Hodgkin's lymphoma more than 3 months after achieving complete remission with treatment.

There is no standard treatment protocol for recurrent Hodgkin's lymphoma. It is usually treated by intensive chemotherapy combined with radiotherapy, or chemotherapy combined with autologous hematopoietic stem cell transplantation. The choice of chemotherapy regimen needs to be based on previous treatment.

Follow-up & Review

1. General

Patients need to be followed up with regular follow-up appointments after the completion of treatment in order to monitor the recurrence and long-term effects of the disease.

2. Review

Long-term follow-up at a comprehensive pediatric oncology center is recommended for children with Hodgkin's lymphoma after treatment is completed in order to detect recurrence and other complications.

The tests required at the time of review are: medical history, physical examination, laboratory tests (complete blood count, erythrocyte sedimentation rate and biochemical tests) and imaging tests.

Routine

1. Daily life management

1) Diet

During and after treatment, patients should maintain a rich and balanced, safe and hygienic diet and good eating habits. Adequate intake of vitamins, minerals, proteins, carbohydrates, fats and water is important for treatment and recovery. Specific dietary advice can be obtained from the dietitian at your hospital.

2) Rest and exercise

Regular and quality sleep is helpful for immunity and physical recovery, so patients need sufficient sleep time and good sleep quality. Providing a good sleeping environment will help to improve the quality of sleep of patients, such as keeping the environment quiet, no noise, dim light and suitable temperature.

If the patient's physical condition permits, the patient should be encouraged and helped to do some appropriate activities. Appropriate activities can enhance physical strength, promote appetite, reduce psychological stress and generate a sense of well-being, which is helpful for treatment and recovery. Consult your doctor if you are physically able to participate in physical activities.

3) Emotional psychology

Patients need to be observed for emotional-psychological changes and seek professional help for psychological interventions if necessary.

2. Daily condition monitoring

In the course of treatment, it is necessary to observe the side effects caused by the treatment, as well as the complications and the regression of the patient's condition, and consult the doctor in time when side effects and complications appear. After the completion of treatment, it is necessary to observe the delayed complications, the growth and development of the child, the recurrence of the disease, and adhere to regular follow-up. When new symptoms or complications appear, consult your doctor.

3. Special Considerations

Records of all patient visits and treatments should be kept for review and reference when seeking medical attention.

4. Prevention

Since the exact cause of Hodgkin's lymphoma is not known, there are no preventive methods that correspond to the cause. However, possible risk factors for its development are EBV infection, immunodeficiency and a family history of the disease. Therefore, the risk of developing Hodgkin's lymphoma can be reduced by preventing EBV infection and actively treating autoimmune diseases to alleviate immunodeficiency. If there is an immediate family member with Hodgkin's lymphoma, appropriate attention can be given to tumor screening.

Cutting-edge Therapeutic & Clinical Research

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References

[1] Chinese People's Republic and Health Commission. Pediatric Hodgkin's lymphoma diagnosis and treatment standard (2019 edition). 2019.

[2] Chinese Society of Clinical Oncology Guidelines Working Committee. Chinese Society of Clinical Oncology (CSCO) Guidelines for the Diagnosis and Treatment of Lymphoma in Children and Adolescents 2020. Hodgkin's Lymphoma. Hodgkin's Lymphoma. 2020.

[3] McClain KL, Kamdar K. I Overview of Hodgkin lymphoma in children and adolescents. In: Park JR, Connor RF (Ed.) UpToDate. Waltham, Mass. 2020.

[4] PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. updated <06/08/ 2020>. Available at: https://www.cancer.gov/types/lymphoma/hp/child-hodgkin-treatment-pdq. Accessed <08/07/2020>. [PMID: 26389170]

[5] W. Robert Liu, Margaret A. Shipp Signaling pathways and immune evasion mechanisms in classical Hodgkin lymphoma, Blood, 2017, 130(21): 2265 -2270.