MEDIX, God. 18 Br. 100  •  Pregledni članak  •  Hematologija i transfuzijska medicina HR ENG

Klasični Hodgkinov limfom: temeljni principi dijagnostike i liječenjaClassical Hodgkin’s lymphoma: basic principles of diagnosis and treatment

Slobodanka Ostojić Kolonić, Vibor Milunović

Klasični je Hodgkinov limfom novotvorina limfoidnoga tkiva obilježena Reed-Sternbergovim stanicama. Često obolijevaju mlađe osobe. Najčešće se očituje bezbolnom limfadenopatijom vratnih regija s općim simptomima ili bez njih. Dijagnosticira se isključenjem drugih uzroka limfadenopatije i patohistološkom analizom ekstirpiranoga limfnoga čvora. PET-CT-om se određuje klinički stadij, stratificira bolest u prognostičke skupine i procjenjuje terapijski odgovor tijekom i nakon liječenja. Zlatni je standard u liječenju kemoterapija prema shemi ABVD s radioterapijom zahvaćenih regija ili bez nje. Oni s uznapredovalom bolešću i čimbenicima rizika ili refraktarnom bolešću, liječe se agresivnije prema shemi BEACOPP, a oni s relapsom, transplantacijom autolognih perifernih matičnih stanica. Zbog velikoga postotka izlječenja valja smanjiti toksičnost uzrokovanu kemoterapijom i radioterapijom i nadzirati bolesnike minimalnim radiološkim metodama. Zaključno, ovaj je hematološki entitet izlječiv u velikom postotku (u oko 85% slučajeva) te čini svijetli primjer u hematološkoj onkologiji. 

Ključne riječi:
antineoplastička kombinirana kemoterapija; Hodgkinov limfom; dijagnostika; radioterapija

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Classical Hodgkin’s lymphoma is malignant lymphoid neoplasm characterised by Reed-Sternberg cells. The disease often occurs in younger population. Painless lymphadenopathy predominantly cervical regions, which can be accompanied with systemic symptoms, is a common clinical presentation of the disease. The diagnosis is based on the exclusion of other possible causes of benign lymphadenopathy and extirpation of involved lymph node followed by pathohistological analysis. The stage and prognosis of the disease are determined using [18F] FDG PET/CT, which is also used in the assessment of treatment response.. The golden standard in the treatment of most patients is tABVD protocol with or without involved-field radiation therapy. In patients with advanced disease and disease refractory to ABVD, BEACOPP protocol is used as a more aggressive therapy. In relapsed disease, high-dose therapy with stem cell rescue is used with the intent to cure. Due to high cure rates, delayed toxicity of chemotherapy and radiotherapy (secondary neoplasms, cardiomyopathy) should be reduced and monitoring should involve minimal use of imaging methods. Hodgkin’s lymphoma has a high cure rate (approximately 85%) and represents a positive example in hematologic oncology. 

Key words:
antineoplastic combined chemotherapy protocols; diagnosis; Hodgkin disease; radiotherapy