Classical Hodgkin lymphoma accounts for approximately 95 percent of all cases of Hodgkin lymphoma, with lymphocyte predominant Hodgkin lymphoma comprising the remaining cases. The classical types are nodular sclerosis (accounting for between 60 percent and 80 percent of all cases of Hodgkin lymphoma) in which the Reid-Sternberg cells (which are visible under a microscope and named after the researchers who identified them) mix with normal white blood cells. The lymph nodes often contain prominent scar tissue, hence the name nodular sclerosis (scarring). The disease is more common in women than men, and it usually affects adolescents and adults under 50. The great majority of patients are cured with current treatments.
Mixed Cellularity Hodgkin accounts for about 15 percent to 30 percent of all cases of Hodgkin lymphoma and is found more commonly in men than women. This subtype primarily affects older adults and may be associated with HIV and the Epstein-Barr virus. More extensive disease is usually present by the time this subtype is diagnosed.
Lymphocyte Depletion accounts for fewer than 5 percent of all Hodgkin cases. It is characterized by few normal lymphocytes, but abundant Reid-Sternberg cells. Lymphocyte Depletion is aggressive and usually not diagnosed until the disease is widespread. Lymphocyte-Rich accounts for less than 5 percent of all Hodgkin cases. The disease may be diffuse (spread out) or nodular (knot-like) in form and is characterized by the presence of numerous normal lymphocytes and very few abnormal cells and classical Reid-Sternberg cells. This subtype of Hodgkin lymphoma is usually diagnosed at an early stage in adults and has a low relapse rate.
The Lymphocyte Predominant Hodgkin Lymphomas account for 5 percent to 10 percent of all Hodgkin cases. It primarily affects more men than women and is usually diagnosed in people under 35. Most of the lymphocytes found in the lymph nodes are not cancerous. Typical Reid-Sternberg cells are usually not found in this subtype, but large, abnormal B-cells can be seen as well as reactive small b-cells. This subtype is usually diagnosed at an early stage and is not aggressive. In many ways, this form of Hodgkin lymphoma resembles indolent b-cell non-Hodgkin lymphoma.
Diffuse Lymphocyte Predominant is very rare and disease recurrence is common in this final subtype of Hodgkin lymphoma.
Classical Hodgkin disease is generally treated with multi-agent chemotherapy often along with radiation therapy. A stem cell transplant may also be recommended for some patients. Brentuximab vedotin (Adcetris) was recently approved to treat Hodgkin disease in certain patients who failed to respond to previous therapies. For those diagnosed with nodular lymphocyte predominant Hodgkin lymphoma, radiation alone may be appropriate for patients with early stage disease. For those with later-stage disease, chemotherapy plus radiation, as well as the monoclonal antibody rituximab may be recommended.