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What's the difference? Hodgkin lymphoma and non-Hodgkin lymphoma

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Patients with either cancer may experience extreme fatigue, weight loss and loss of appetite, fever and sweats and other common symptoms. And both are named for Dr. Thomas Hodgkin, the ground-breaking researcher who chronicled symptoms of the diseases. But there are important differences between the two.

With a common origin, similar symptoms and a shared name, Hodgkin lymphoma and non-Hodgkin lymphoma are easy to confuse. Both cancers originate in the lymphatic system, the body's network of lymph nodes that dispatch white blood cells called B lymphocytes. These cells produce antibodies that help us fight off infections. Patients with either cancer may experience extreme fatigue, weight loss and loss of appetite, fever and sweats and other common symptoms. And both are named for Dr. Thomas Hodgkin, the ground-breaking researcher who chronicled symptoms of the diseases. But there are important differences between the two.

The primary diagnostic difference between Hodgkin and non-Hodgkin lymphomas may be determined during a biopsy, usually of an affected lymph node. If a pathologist discovers Reed-Sternberg cells in the biopsy, the patient is diagnosed with Hodgkin lymphoma. Reed-Sternberg cells, named for the two scientists who first identified them under a microscope, are mutated B lymphocytes that are huge by cellular standards—up to five times larger than normal lymphocytes. One common variety of these cells has at least two nuclei that give them the appearance of an owl's eyes. Another variety is called a popcorn cell because of its lobular shape. The different shapes of Reed-Sternberg cells may help pathologists determine the specific type of Hodgkin lymphoma.

The main differences

A number of other differences distinguish the two diseases. For instance:

Hodgkin lymphoma Non-Hodgkin lymphoma
Thirty-two percent of patients diagnosed with Hodgkin lymphoma are 20-34 years old. The median age of a patient diagnosed with the disease is 39. Seventy-five percent of patients diagnosed with Hodgkin lymphoma 55 or older. The median age of a patient diagnosed with the disease is 66.
Hodgkin lymphoma is rare, accounting for about .5 percent of all new cancers diagnosed. An estimated 8,500 cases were diagnosed in 2016. Non-Hodgkin lymphoma is the seventh most diagnosed cancer, accounting for an estimated 72,500 cases in 2016.
More than 86 percent of patients diagnosed with Hodgkin lymphoma survive five years or more. About 70 percent of patients diagnosed with non-Hodgkin lymphoma survive five years or more.
There are six varieties of Hodgkin lymphoma. The most common forms are nodular sclerosis classical Hodgkin lymphoma and mixed cellularity classical Hodgkin lymphoma. They account for about 90 percent of all cases. There are more than 61 types and subtypes of non-Hodgkin lymphoma. B-cell lymphomas account for 85 percent of all cases. Diffuse large B-cell lymphoma is the most common form on non-Hodgkin lymphoma.
Sources: National Cancer Institute and Lymphoma Research Foundation

Hodgkin, a British pathologist, first chronicled some of the symptoms of the disease in a landmark 1832 article detailing the postmortem examinations of several patients with enlarged lymph nodes and spleens. Thirty years later, another British physician, Dr. Samuel Wilks, learned of Hodgkin's work while conducting similar research. He named the condition Hodgkin's disease. The name of the disease has since lost the possessive and is called either Hodgkin disease or Hodgkin lymphoma. Decades after Hodgkin’s findings, researchers were better able to recognize that lymphomas could be categorized by two distinct types—Hodgkin and a similar but markedly different variety, non-Hodgkin.

Treatments for lymphoma

Both diseases may be treated with chemotherapy, radiation therapy and/or stem cell transplantation. Targeted therapy drugs such as ibritumomab tiuxetan (Zevalin®) or rituximab (Rituxan®) may be combined with radiation therapy or chemotherapy to treat non-Hodgkin lymphoma. Nivolumab (Opdivo®), an immunotherapy drug known as a checkpoint inhibitor, has been approved to treat Hodgkin lymphoma. In December 2016, the U.S. Food and Drug Administration granted priority review of the checkpoint inhibitor pembrolizumab (Keytruda®) to treat Hodgkin lymphoma. And multiple clinical trials are underway to determine if immunotherapy drugs may also help treat non-Hodgkin lymphoma and other hematological malignancies, such as multiple myeloma. "The early data suggests immunotherapy will play a future role in the management of lymphomas," says Dr. Maurie Markman, President of Medicine and Science for Cancer Treatment Centers of America® (CTCA).