B72 Hodgkin’s disease/lymphoma (ICD-10:C81)

Introduction

Hodgkin lymphoma, also known as Hodgkin’s disease, is a malignant lymphoproliferative disorder that originates in the lymphatic system^[1]. It is characterized by the presence of Reed-Sternberg cells, which are large abnormal multinucleated cells that are pathognomonic for this disease^[2]. Hodgkin lymphoma represents approximately 11% of all lymphomas in the United States and has a distinctive bimodal age distribution, with peak incidence in young adults aged 20-40 years and a second peak in individuals over 55 years^[3].

Codes

• ICPC-2 Code: B72 Hodgkin’s disease/lymphoma^[4]
• ICD-10 Code: C81 Hodgkin lymphoma^[5]

Symptoms

• Enlarged lymph nodes: Painless, firm lymphadenopathy, most commonly in the neck, armpits, or groin regions^[6]
• B symptoms: Constitutional symptoms including fever >38°C, drenching night sweats, and unexplained weight loss >10% of body weight within 6 months^[7]
• Persistent fatigue: Marked weakness and reduced energy levels that interfere with daily activities^[8]
• Pruritus: Generalized itching, which may be severe and is present in approximately 25% of patients^[9]
• Chest symptoms: Chest pain, cough, or shortness of breath due to mediastinal lymphadenopathy^[10]
• Abdominal symptoms: Pain or swelling in the abdomen due to enlarged lymph nodes or splenic involvement^[11]
• Alcohol-induced pain: Rare but pathognomonic symptom where lymph nodes become painful within minutes of alcohol consumption^[12]

Causes

• Epstein-Barr virus (EBV) infection: Present in 40-50% of classical Hodgkin lymphoma cases, with EBV-positive patients having increased risk^[13]
• Immunodeficiency: HIV infection increases risk 5-15 fold, with nearly all HIV-associated cases being EBV-positive^[14]
• Family history: First-degree relatives have 3-9 times increased risk, with highest risk among same-sex siblings^[15]
• Age and gender: Males slightly more affected (male:female ratio 1.4:1), with bimodal age distribution^[16]
• Genetic predisposition: HLA associations and specific gene polymorphisms contribute to susceptibility^[17]
• Autoimmune disorders: Increased risk in patients with rheumatoid arthritis, sarcoidosis, and other autoimmune conditions^[18]

Diagnostic Steps

Medical History

• Comprehensive symptom assessment including B symptoms, duration of lymphadenopathy, and functional status^[19]
• Family history of hematologic malignancies and autoimmune disorders^[20]
• History of infectious mononucleosis, HIV status, and immunosuppressive conditions^[21]
• Assessment of alcohol-induced pain and pruritus patterns^[22]

Physical Examination

• Systematic examination of all accessible lymph node regions^[23]
• Assessment of lymph node characteristics: size, consistency, mobility, and associated symptoms^[24]
• Evaluation for hepatosplenomegaly and extranodal involvement^[25]
• Performance status assessment using ECOG or Karnofsky scales^[26]

Laboratory Tests

• Complete blood count (CBC): May show anemia, leukocytosis, lymphopenia, or eosinophilia^[27]
• Inflammatory markers: Elevated ESR (>30 mm/hr) and LDH levels indicate disease activity^[28]
• Liver and kidney function tests: Baseline assessment for treatment planning and staging^[29]
• Serum protein electrophoresis: May show hypergammaglobulinemia or hypoalbuminemia^[30]
• Viral serology: HIV, hepatitis B/C, and EBV testing^[31]

Diagnostic Imaging

• PET/CT scan: Gold standard for staging, with superior accuracy compared to CT alone; upstages disease in 9-41% of patients^[32]
• Chest X-ray: Initial imaging to detect mediastinal masses, though PET/CT has largely replaced it^[33]
• CT scans: Detailed anatomical imaging of chest, abdomen, and pelvis when PET/CT unavailable^[34]
• MRI: May be used for specific anatomical areas or when CT contrast is contraindicated^[35]

Tissue Diagnosis

• Lymph node biopsy: Excisional biopsy preferred over needle biopsy for adequate tissue architecture assessment^[36]
• Histopathological examination: Identification of Reed-Sternberg cells and Hodgkin cells is essential for diagnosis^[37]
• Immunophenotyping: CD30+ and CD15+ in classical Hodgkin lymphoma; CD20+ in nodular lymphocyte-predominant subtype^[38]
• Bone marrow biopsy: Generally not required unless clinical suspicion of bone marrow involvement^[39]

Follow-up and Patient Education

• Regular monitoring during treatment with imaging, laboratory tests, and clinical assessment^[40]
• Education on treatment-related side effects, fertility preservation, and long-term survivorship issues^[41]
• Counseling on infection prevention during immunosuppressive therapy^[42]

Possible Interventions

Traditional Interventions

Chemotherapy Regimens:

ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine):

• Cost: $277 per 28-day cycle in the US^[43]
• Standard first-line therapy for advanced Hodgkin lymphoma
• Contraindications: Severe cardiac dysfunction, active infection, pregnancy
• Side effects: Nausea, alopecia, fatigue, peripheral neuropathy
• Severe side effects: Bleomycin-induced pulmonary toxicity (1-3%), cardiotoxicity
• Warning: Requires pulmonary function monitoring; cardiac function assessment^[44]

Escalated BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone):

• Cost: $4,445 per cycle including G-CSF support^[43]
• Superior efficacy compared to ABVD (7-12% improvement in treatment failure rates) but higher toxicity^[45]
• Side effects: Severe myelosuppression, infertility, secondary malignancies
• Warning: Requires growth factor support and intensive monitoring^[46]

Brentuximab vedotin + AVD (A+AVD):

• Cost: $33,834 per 28-day cycle (>100 times more expensive than ABVD)^[43]
• FDA-approved first-line therapy based on ECHELON-1 trial results
• Improves progression-free survival compared to ABVD
• Side effects: Peripheral neuropathy (67%), neutropenia, tumor lysis syndrome
• Severe side effects: Progressive multifocal leukoencephalopathy (rare)
• Warning: Monitor for neuropathy; dose modifications may be required^[47]

Nivolumab (Opdivo):

• Cost: Approximately $12,000 per vial^[48]
• PD-1 inhibitor for relapsed/refractory disease
• Side effects: Fatigue, rash, diarrhea, immune-related adverse events
• Warning: Monitor for immune-mediated pneumonitis, hepatitis, and endocrinopathies^[49]

Radiation Therapy:

• Involved-site radiation therapy (ISRT): 20-30 Gy for consolidation in early-stage disease^[50]
• Post-transplant consolidative radiation: Improves progression-free survival by 25% in relapsed disease^[51]

Surgical Procedures:

• Autologous stem cell transplantation: First-line salvage therapy for relapsed/refractory disease with 70-80% cure rates^[52]
• Allogeneic stem cell transplantation: Reserved for multiple relapses or transplant-ineligible patients^[53]

Alternative and Supportive Interventions

• Acupuncture: May help manage chemotherapy-induced nausea and peripheral neuropathy; costs $60-120 per session^[54]
• Mind-body techniques: Meditation, yoga, and mindfulness for stress reduction and quality of life improvement^[55]
• Nutritional counseling: Maintaining adequate nutrition during treatment to support immune function and healing^[56]
• Exercise therapy: Supervised exercise programs improve fatigue, physical function, and quality of life^[57]

Lifestyle Interventions

• Infection prevention: Strict hygiene practices, avoiding crowds, and prompt medical attention for fevers during treatment^[58]
• Fertility preservation: Sperm banking or egg freezing before treatment, particularly with BEACOPP regimens^[59]
• Smoking cessation: Essential to reduce pulmonary toxicity risk, particularly with bleomycin-containing regimens^[60]
• Immunizations: Live vaccines contraindicated during treatment; inactivated vaccines recommended pre-treatment^[61]
• Long-term surveillance: Regular follow-up for secondary malignancies, cardiac toxicity, and endocrine dysfunction^[62]
• Psychosocial support: Counseling and support groups for coping with cancer diagnosis and treatment^[63]

Note: Cost ranges reflect US healthcare pricing and may vary significantly by geographic location, insurance coverage, and healthcare system. Treatment selection should be individualized based on patient factors, disease stage, and institutional expertise. The high cure rate (>90% in early stages, 80-85% in advanced stages) makes Hodgkin lymphoma one of the most curable adult malignancies^[64].

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – B72 Hodgkin’s disease/lymphoma (ICD-10:C81)

Mild	Moderate	Severe
Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 1 (Infection) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 2 (Wound Healing) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 3 (Antiviral Therapy) Location: 0 (Localized) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 3 (Antiviral Therapy) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 3 (Antiviral Therapy) Location: 0 (Localized) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Total Morning: 60 minutes approx. $10 USD, Evening: 60 minutes approx. $10 USD	Total Morning: 120 minutes approx. $20 USD, Lunch: 120 minutes approx. $20 USD, Evening: 120 minutes approx. $20 USD,	Total Morning: 120 minutes approx. $20 USD, Lunch: 120 minutes approx. $20 USD, Evening: 120 minutes approx. $20 USD,
Usual treatment for 7-60 days approx. $140 USD – $1200 USD	Usual treatment for 6-8 weeks approx. $2,520 USD – $3,360 USD	Usual treatment for 3-6 months approx. $5,400 USD – $10,800 USD

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Hodgkin’s disease/lymphoma effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Hodgkin’s disease/lymphoma. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It has received clearance from the U.S. FDA and is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

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36. Science Direct. (2022). Impact of Radiation Therapy After High Dose Chemotherapy and Autologous Stem Cell Transplantation. https://www.sciencedirect.com/science/article/abs/pii/S2152265021020322
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48. PMC. (2019). Cure at what (systemic) financial cost? Integrating novel agents into front-line therapy of Hodgkin lymphoma. https://pmc.ncbi.nlm.nih.gov/articles/PMC6913455/
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51. PMC. (2017). Role of Consolidative Radiation Therapy After Autologous Stem Cell Transplantation for Relapsed or Refractory Hodgkin Lymphoma. https://pmc.ncbi.nlm.nih.gov/articles/PMC5744586/
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62. The Medical Letter. (2018). Brentuximab Vedotin (Adcetris) for Classical Hodgkin’s Lymphoma. https://secure.medicalletter.org/TML-article-1559e
63. Takeda Oncology. (2025). ADCETRIS® (brentuximab vedotin) Cost and Resources. https://www.adcetris.com/classical-hodgkin-lymphoma/resources/
64. National Centre for Pharmacoeconomics. (2021). Cost-effectiveness of brentuximab vedotin (Adcetris®) for CD30+ Hodgkin lymphoma. http://ncpe.ie/wp-content/uploads/2021/10/Technical-Summary-Brentuximab-vedotin-19058.pdf