Anales de la RANM

97 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 LINFOMA DE HODGKIN Fernández-Rañada JM An RANM. 2022;139(01): 88 - 99 Su comportamiento remeda a los linfomas no Hodgkin de bajo grado de malignidad, con un curso evolutivo indolente y propensión a las recaídas tardías. El LHPLN es más común en hombres, en general de mediana edad o mayores y habitual- mente se presenta con enfermedad ganglionar en cuello y respeta el mediastino. Los síntomas constitucionales son raros, es decir en la mayoría de los casos el diagnóstico inicial se realiza en un estadio precoz de la enfermedad. Desde el punto de vista terapéutico los estadios I-A se tratan con radioterapia local. En estadios intermedios de la enfermedad, se utiliza un tratamiento combinado quimioradioterá- pico. Habitualmente se preconiza 2 o 4 ciclos de ABVD, con 2 o 3 Gy de radioterapia según la enfermedad tenga criterios de forma localizada favorable o adversa. Los estadios avanzados se tratan con quimioterapia, bien ABVD o BEACOPP o tratamiento PET-2 adaptado y con un uso juicioso eventualmente de la radioterapia. Dada la positividad CD20 de las células tumorales, se asocia rituximab a los esquemas quimioterápicos. Ordinariamente las recaídas se tratan con quimio- terapia de segunda línea asociada a anti-CD20 y eventualmente combinadas con radioterapia. En casos seleccionados, algunos pacientes pueden ser candidatos a quimioterapia de rescate seguida por trasplante autólogo de progenitores hemato- poyéticos. 1. Ansell SM. Hodgkin lymphoma: A 2020 update on diagnosis, risk-stratification, and manage- ment. Am J Hematol. 2020;95:978-989. 2. Wang HW, Balakrishna JP, Pittaluga S, et al. Diagnosis of Hodgkin lymphoma in the modern era. Br J Hematol. 2019;184:45-59. 3. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. N Engl J Med. 1998;1506-1514. 4. Devita VT Jr, Serpick AA, Carbone PP. Com- bination Chemotherapy in the treatment of advanced Hodgkin’s Disease. Ann Inter Med. 1970;73:881-895. 5. Devita VT Jr, Simon RM, Hubbard SM, et al. Cu- rability of Advanced Hodgkin’s disease with Che- motherapy. Ann Inter Med. 1980;92:587-595. 6. Bonadonna G, Zucall R, Monfardini S, et al. Combination Chemotherapy of Hodgkin’s disea- se with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975.36:252-259. 7. Reid JH, Marini BL, Nachar VR, et al. Contem- porary treatment options for a classical disease: Advanced Hodgkin lymphoma. Critical Rev On- col. 2020;148:1-13. 8. Engert A, Diehl C, Franklin J. et al. Escalated- Dose BEACOPP in the treatment of patients with Advanced-Stage Hodgkin’s Lymphoma: 10 Years of Follow-Up of the GHSG HD9 Study. J Clin Oncology. 2009;27:4548-4554. 9. Chen R, Gopal AK, Smith SE, et al. Five-year survival and durability results of brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2016;128:1562- 1566. 10. Armand P, Engert A, Younes A, et al. Nivolumab for relapsed/refractory classic Hodgkin Lym- phoma after failure of autologous hematopoie- tic cell transplantation: Extended Follow-Up of the Multicohort Single-Arm Phase II CheckMa- te 205 Trial. J Clin Oncol. 2018;36:1428-1439. 11. Herrera AF, Moskowitz AJ, Barlett NL., et al. Interim results of brentuximab vedotin in com- bination with nivolumab in patients with relap- sed or refractory Hodgkin lymphoma. Blood 2018;131:1183-1194. 12. Engert A, Franklin J, Eich T, et al. Two Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin’s Lymphoma: Final results of the GHSG HD7 Trial. J Clin Oncol 2007;25:3495-3502. 13. Raemaekers JMM, André MPE, Federico M., et al. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hod- gkin Lymphoma is associated with an increa- sed risk of early relapse: Clinical results of the preplanned interim analysis of the randomi- zed EORTC/LYSA/FIL H10 Trial. J Clin Oncol 2014;32:1188-1194. 14. Engert A, Plütschow A, Eich HT, et al. Redu- ced treatment intensity in patients with early- stage Hodgkin’s Lymphoma. N Engl J Med 2010;363:640-652. 15. Eich HT, Diehl V, Görgen H, et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavora- ble Hodgkin’s Lymphoma: Final analysis of the German Hodgkin study group HD11 Trial. J Clin Oncol 2010;28:4199-4206. 16. Tresckow BV, Plütschow A, Fuchs M, et al. Dose-intensification in Early unfavorable Hodgkin’s Lymphoma: Final analysis of the German Hodgkin study group HD14 Trial. J Clin Oncol 2012;30:907-913. 17. Raemaekers JMM, André MPE, Federico M., et al. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hod- gkin Lymphoma is associated with an increa- sed risk of early relapse: Clinical results of the preplanned interim analysis of the randomi- zed EORTC/LYSA/FIL H10 Trial. J Clin Oncol 2014;32:1188-1194. 18. Fermé C, Eghbali H, Meerwaldt JH, et al. Che- motherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 2007;357:1916-1927. 19. André MPE, Girinsky T, Federico M, et al. Early positron emission tomography response- adapted treatment in stage I and II Hodgkin Lymphoma: Final results of the randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol 2017;35:1786-1794. 20. Radford J, Illidge T, Counsell N, et al. Results of a trial of PET-directed therapy for early- stage Hodgkin’s Lymphoma. N Engl J Med 2015;372:1598-1607. BIBLIOGRAFÍA