Hodgkin's disease: Unfolding concepts concerning its nature, management and prognosis

Abstract

The evolution of our concepts concerning the fundamental nature and natural history of Hodgkin's disease is reviewed. Recent evidence establishes that it is indeed a malignant neoplasm, albeit a curious one, the giant cells of which display aneuploid karyotypes, often with marker chromosomes indicating their clonal derivation, and the functional and surface marker properties of cells of the mononuclear phagocyte series. The disease tends initially to spread by contiguity from one lymph node chain to others with which direct lymphatic channel communications exist. Essentially all patients, even those with limited disease, have some degree of impairment of cell-mediated immunity, apparently due to inhibition of T-lymphoc,yte function. Lymphangiography, computed tomography, and laparotomy with splenectomy have greatly improved the accuracy of clinical staging. Total lymphoid megavoltage radiotherapy andlor multidrug combination chemotherapy now permit the eradication of disease of all stages, resulting in a dramatic impruvement in prognosis and an increasing frequency of permanent cure of this once inevitably fatal condition. Cancer 452439-2474. 1980. T IS NOW ALMOST 150 YEARS since Thomas Hodgkin

Tumour burden in early stage Hodgkin's disease: the single most important prognostic factor for outcome after radiotherapy

“…As a result of modern therapeutic advances histologic subtype has in many studies in recent years shown a diminishing influence on prognosis in the sense that the difference in prognosis between NS and MC has been virtually eliminated in early stage disease (Kaplan, 1980a). In the present study histologic subtype is a significant prognostic factor with LP having the best and MC the poorest disease free survival.…”

Lymphocyte function in untreated Hodgkin's disease: An important predictor of prognosis

“…THE CURRENT REGIMENS of therapy for and impaired host defences against certain HD have produced a major decrease in the infections (Goffinett et al, 1972; Weitzman overall death rate, with long-term relapse-& Aisenberg, 1977; Askergren & Bjorkfree survival and cure in the vast majority holm, 1980) have been noted. By better of young (< 45 years) patients with early-identification of "good prognosis" patients stage disease (Kaplan, 1980a). However, one might be able to reduce the total some young and many elderly patients do amount of radio-and chemotherapy withnot enter complete remission, or relapse out losing the therapeutic effectiveness.…”

Reevaluation of alkaline phosphatase measurement during Hodgkin's disease by electrophoretic isoenzyme separation

“…Biological tests such as the bilirubin concentration, BSP retention, gammaglutamyl transpeptidase, oxaloacetic or glutamatepyruvate transaminases, or 5-nucleotidase (which is useful in the case of malignant lymphomas) are not commonly employed (Belliveau et al, 1974;Deeble & Goldberg, 1980). Alkaline phosphatases appear more useful: numerous studies have shown a clear correlation between the AP concentration and the disease stage (Belliveau et al, 1979;Deeble & Goldberg, 1980;Aisenberg et al, 1970;Kaplan, 1980), whether or not there is any histologically proven liver involvement. The actual significance of elevation of AP levels remains unclear: an unexplained and occasionally intense liver retention syndrome has been observed for some time, disappearing in some cases after supradiaphragmatic radiotherapy of stage I or II disease (Perera et al, 1974).…”