In 2005, there will be an estimated 7,350 new cases and 1,410 deaths from Hodgkin's lymphoma (also known as Hodgkin's disease) in the United States.1 Careful staging and treatment planning by a multidisciplinary team of cancer specialists are required to determine the optimal treatment for patients with this disease.2

Hodgkin's lymphoma is differentiated by presence of Reed-Sternberg (R-S) cells in the area of malignancy. Reed-Sternberg cells are believed to be a form of malignant B lymphocyte. Recent studies have confirmed the B-cell origin of the R-S cell. Single-cell polymerase chain reaction analysis of classic R-S cells shows a follicular center of B-cell origin with clonally rearranged but compromised V heavy-chain genes, possibly inhibiting apoptosis. High levels of the nuclear transcription factor kappa-B (NF-κB) have also been found in R-S cells, potentially affecting pathogenesis by inhibiting apoptosis. The R-S cell is characterized by its large size and classic binucleated structure with large eosinophilic nucleoli.3


Reed-Sternberg (R-S) Cell

More than 75% of all newly diagnosed patients with adult Hodgkin's lymphoma can be cured with combination chemotherapy and/or radiation therapy. National mortality has fallen more rapidly for adult Hodgkin's lymphoma than for any other malignancy, largely due to excellent results achieved with modern radiation therapy and effective combination chemotherapy.2

Prognosis for a given patient depends on several factors. The most important factors are the presence or absence of systemic symptoms, the stage of disease, presence of large masses, and the quality and suitability of the treatment administered. Other important factors are age (therapy for very young children requires special attention), sex, erythrocyte sedimentation rate, number of splenic nodules, extent of abdominal involvement, hematocrit, and absolute number of nodal sites of involvement.2,4,5

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Staging in Hodgkin's Lymphoma6

Stage I adult Hodgkin's lymphoma is characterized by the involvement of a single lymph node region or localized involvement of a single extralymphatic organ or site.

Stage II adult Hodgkin's lymphoma is characterized by the involvement of 2 or more lymph node regions on the same side of the diaphragm or localized involvement of a single associated extralymphatic organ or site and its regional lymph node(s) with or without involvement of other lymph node regions on the same side of the diaphragm.

Stage III is characterized by the involvement of lymph node regions on both sides of the diaphragm, which may also be accompanied by localized involvement of an associated extralymphatic organ or site, by involvement of the spleen, or by involvement of both. Stage III disease may be subdivided by anatomic distribution of abdominal involvement or by extent of splenic involvement and may indicate involvement that is limited to the upper abdomen above the renal vein; and indicate involvement of pelvic and/or para-aortic nodes.

Stage IV is characterized by disseminated (multifocal) involvement of 1 or more extralymphatic organs, with or without associated lymph node involvement, or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement.

Portions of this information on Hodgkin's lymphoma are reproduced courtesy of the National Cancer Institute: www.nci.nih.gov.

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References:

  1. American Cancer Society. Cancer facts & figures 2005. Available at: http://www.cancer.org/docroot/STT/stt_0.asp. Accessed June 17, 2005.
  2. National Cancer Institute. General information. In: Adult Hodgkin's Lymphoma (PDQ®): Treatment. Available at: http://nci.nih.gov/cancertopics/pdq/treatment/ adulthodgkins/healthprofessional. Accessed June 17, 2005.
  3. Yahalom J, Straus D. Hodgkin's disease. In: Pazdur R, Coia LR, Hoskins WJ, Wagman LD, eds. Cancer Management: A Multidisciplinary Approach. 7th ed. New York, NY: The Oncology Group; 2003:643-663.
  4. Kennedy BJ, Loeb V Jr, Peterson V, Donegan W, Natarajan N, Mettlin C. Survival in Hodgkin's disease by stage and age. Med Pediatr Oncol. 1992;20:100-104.
  5. Cosset JM, Henry-Amar M, Meerwaldt JH, et al. The EORTC trials for limited stage Hodgkin's disease. The EORTC Lymphoma Cooperative Group. Eur J Cancer. 1992;28:1847-1850.
  6. National Cancer Institue. Stage Information. In: Adult Hodgkin's Lymphoma (PDQ®): Treatment. Available at: http://www.nci.nih.gov/cancertopics/pdq/ treatment/adulthodgkins/HealthProfessional/page3. Accessed June 17, 2005.

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Important Safety Information

WARNING
It is recommended that MATULANE be given only by or under the supervision of a physician experienced in the use of potent antineoplastic drugs. Adequate clinical and laboratory facilities should be available to patients for proper monitoring of treatment.

Matulane is contraindicated in patients with known hypersensitivity to the drug or inadequate marrow reserve as demonstrated by bone marrow aspiration. Due consideration of this possible state should be given to each patient who has leukopenia, thrombocytopenia, or anemia.

Matulane in combination therapy is a potent chemotherapeutic agent. Before prescribing Matulane, the sections in the Prescribing Information concerning usage in pregnancy, occurrence of secondary cancers, monitoring required in liver and kidney disease, hematologic effects, CNS effects, and potentiation associated with alcohol and MAO inhibitors should be carefully evaluated.

Please see full Prescribing Information for Matulane indications and usage, contraindications, and warnings including boxed WARNINGS, precautions, and adverse reactions.