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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Oncology

Understanding Your Diagnosis: Classic Hodgkin Lymphoma

At a Glance

Classic Hodgkin Lymphoma (cHL) is a highly curable cancer of the lymphatic system. Care is highly personalized using PET-CT scans, often combining chemotherapy with targeted therapies. Because cHL frequently affects young adults, discussing fertility preservation is a critical first step.

Receiving a diagnosis of classic Hodgkin Lymphoma (cHL) can feel overwhelming, but it is important to know that you are facing one of the most treatable and curable forms of cancer [1][2]. While the word “cancer” is frightening, medical research and treatment for this specific disease have advanced so significantly that the vast majority of patients achieve a long-term cure [3][4].

Understanding the Disease

Classic Hodgkin Lymphoma is a type of cancer that begins in the lymphatic system, which is part of your body’s immune-fighting network [5]. It is characterized by the presence of very specific, large cells called Hodgkin and Reed-Sternberg (HRS) cells [6].

Interestingly, these HRS cells usually make up only a tiny fraction of the tumor [7]. The rest of the mass is actually composed of normal, healthy immune cells that have been “tricked” into surrounding and protecting the cancer cells [8]. Understanding this unique environment has allowed doctors to develop treatments that unmask the cancer so the immune system can attack it effectively [9].

Key Facts to Hold On To

As you begin this journey, keep these stabilizing facts in mind:

  • It is uncommon: About 8,500 people are diagnosed with cHL in the United States each year, making up roughly 10% of all lymphomas [10][11].
  • It follows a bimodal age pattern: This means the disease most commonly affects two distinct groups: young adults (ages 15–34) and older adults (age 50 and older) [12][13].
  • It is highly curable: Even if the cancer is found in an advanced stage (Stage III or IV), modern treatments are designed to be curative, with survival rates continuing to improve year after year [14][15].
  • Treatment is personalized: Doctors now use PET-CT scans during treatment to see how well you are responding. This allows them to “risk-adapt” your care—meaning they can potentially reduce treatment intensity if the cancer is disappearing quickly or strengthen it if needed [3][4].

A Critical Note on Fertility Preservation

Because classic Hodgkin Lymphoma frequently occurs in young adults, the treatments used to cure the disease can unfortunately impact your ability to have children in the future [4]. Before beginning any chemotherapy or radiation, it is critical to have a direct conversation with your oncologist about fertility preservation (such as egg freezing, sperm banking, or ovarian tissue preservation). While you may feel an urgent need to start cancer treatment immediately, taking a week or two to preserve your fertility is a standard and crucial step in your care plan.

What to Expect Initially

Your medical team’s first priority is to create a complete map of the disease. This process, called staging, involves imaging tests and biopsy reviews to determine exactly where the lymphoma is located [16].

While you may feel a sense of urgency, taking the time to get an accurate “baseline” is critical for choosing the right path [3]. You will likely hear about frontline therapy, which is the first combination of medications used to treat the disease. Today, these regimens often include a mix of traditional chemotherapy and newer, targeted therapies [17]. As the disease and treatments evolve, doctors are also beginning to incorporate immune checkpoint inhibitors (like nivolumab or pembrolizumab) into frontline care for certain advanced cases, though these are more commonly used if the disease returns [18][19].

You are not alone in this; because cHL is a well-understood disease, there are clear, evidence-based protocols designed to get you back to your life [3].

Common questions in this guide

What are Hodgkin and Reed-Sternberg (HRS) cells?
HRS cells are large, specific cancer cells that are the hallmark of classic Hodgkin Lymphoma. Interestingly, they make up only a tiny fraction of a tumor, while the rest consists of normal immune cells that have been tricked into protecting the cancer cells.
Is classic Hodgkin Lymphoma curable?
Yes, classic Hodgkin Lymphoma is one of the most treatable and curable forms of cancer. Even if it is diagnosed at an advanced stage, modern personalized treatments are designed with the goal of completely curing the disease.
Who is most likely to get classic Hodgkin Lymphoma?
This disease most commonly affects two distinct age groups. It is most frequently diagnosed in young adults between the ages of 15 and 34, and in older adults who are 50 and older.
Why do I need to think about fertility preservation before treatment?
The treatments used to cure classic Hodgkin Lymphoma, such as chemotherapy and radiation, can significantly impact your future ability to have children. It is standard medical practice to take a week or two to preserve fertility, such as through egg freezing or sperm banking, before starting therapy.
How will my doctor track if my lymphoma treatment is working?
Doctors use PET-CT scans during your treatment to see how well the cancer is responding. This allows them to personalize your care by potentially reducing treatment intensity if the cancer is disappearing quickly, or strengthening the treatment if needed.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my specific subtype of classic Hodgkin Lymphoma, and how does that influence the plan?
  2. 2.Based on my initial scans, is my disease considered early-stage or advanced-stage?
  3. 3.What is the timeline for discussing and completing fertility preservation before we start treatment?
  4. 4.How do you use PET-CT scans to track my progress during the first few months?
  5. 5.Will we be using any of the newer targeted or immune-based therapies alongside standard chemotherapy?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials.

    von Tresckow B, Kreissl S, Goergen H, et al.

    The Lancet. Haematology 2018; (5(10)):e462-e473 doi:10.1016/S2352-3026(18)30140-6.

    PMID: 30290903
  2. 2

    Resources-Stratified Guidelines for Classical Hodgkin Lymphoma.

    Relecom A, Federico M, Connors JM, et al.

    International journal of environmental research and public health 2020; (17(5)) doi:10.3390/ijerph17051783.

    PMID: 32182952
  3. 3

    PET-adapted approaches to primary therapy for advanced Hodgkin lymphoma.

    Lang N, Crump M

    Therapeutic advances in hematology 2020; (11()):2040620720914490 doi:10.1177/2040620720914490.

    PMID: 32537115
  4. 4

    Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients.

    Dann EJ, Bairey O, Bar-Shalom R, et al.

    British journal of haematology 2017; (178(5)):709-718 doi:10.1111/bjh.14734.

    PMID: 28589704
  5. 5

    Hodgkin lymphoma: Pathology and biology.

    Mathas S, Hartmann S, Küppers R

    Seminars in hematology 2016; (53(3)):139-47.

    PMID: 27496304
  6. 6

    Classic Hodgkin lymphoma: An illustrative review of select diagnostic limitations and immunomorphological challenges.

    El Hussein S, O'Malley DP

    Human pathology 2025; (156()):105678 doi:10.1016/j.humpath.2024.105678.

    PMID: 39491628
  7. 7

    Checkpoint inhibition enhances cell contacts between CD4+ T cells and Hodgkin-Reed-Sternberg cells of classic Hodgkin lymphoma.

    Yadigaroglu K, Scharf S, Gretser S, et al.

    Haematologica 2024; (109(10)):3295-3304 doi:10.3324/haematol.2023.284512.

    PMID: 38779721
  8. 8

    Significance of trogocytosis and exosome-mediated transport in establishing and maintaining the tumor microenvironment in lymphoid malignancies.

    Kawashima M, Higuchi H, Kotani A

    Journal of clinical and experimental hematopathology : JCEH 2021; (61(4)):192-201 doi:10.3960/jslrt.21005.

    PMID: 34193756
  9. 9

    Genomic Landscape of Hodgkin Lymphoma.

    Brune MM, Juskevicius D, Haslbauer J, et al.

    Cancers 2021; (13(4)) doi:10.3390/cancers13040682.

    PMID: 33567641
  10. 10

    Hodgkin lymphoma: A 2020 update on diagnosis, risk-stratification, and management.

    Ansell SM

    American journal of hematology 2020; (95(8)):978-989 doi:10.1002/ajh.25856.

    PMID: 32384177
  11. 11

    Hodgkin lymphoma: 2018 update on diagnosis, risk-stratification, and management.

    Ansell SM

    American journal of hematology 2018; (93(5)):704-715 doi:10.1002/ajh.25071.

    PMID: 29634090
  12. 12

    Greater attention should be paid to developing therapies for elderly patients with Hodgkin lymphoma-A population-based study from Sweden.

    Björkholm M, Weibull CE, Eloranta S, et al.

    European journal of haematology 2018; (101(1)):106-114 doi:10.1111/ejh.13090.

    PMID: 29727497
  13. 13

    Characterizing age-related differences in Hodgkin lymphoma in children, adolescents and young adults.

    Kendel NE, Stanek JR, Willen FK, Audino AN

    Pediatric hematology and oncology 2024; (41(5)):336-345 doi:10.1080/08880018.2024.2337627.

    PMID: 38587477
  14. 14

    Long-Term Survival Rates of Patients with Stage III-IV Hodgkin Lymphoma According to Age, Sex, Race, and Socioeconomic Status, 1984-2013.

    Li Y, Sun H, Yan Y, et al.

    The oncologist 2018; (23(11)):1328-1336 doi:10.1634/theoncologist.2017-0541.

    PMID: 29739895
  15. 15

    Contemporary Outcomes for Advanced-Stage Classical Hodgkin Lymphoma in the U.S.: Analysis of Surveillance, Epidemiology, and End Results Database.

    Guru Murthy GS, Szabo A, Hamadani M, et al.

    The oncologist 2019; (24(11)):1488-1495 doi:10.1634/theoncologist.2019-0172.

    PMID: 31467178
  16. 16

    American Registry of Pathology Expert Opinions: Immunohistochemical evaluation of classic Hodgkin lymphoma.

    O'Malley DP, Dogan A, Fedoriw Y, et al.

    Annals of diagnostic pathology 2019; (39()):105-110 doi:10.1016/j.anndiagpath.2019.02.001.

    PMID: 30802809
  17. 17

    Matching-adjusted indirect treatment comparison of A+AVD vs PET-guided ABVD in newly diagnosed advanced Hodgkin lymphoma.

    Kristo F, Molinari A, Lan Z, et al.

    Future oncology (London, England) 2026; (22(7)):843-852 doi:10.1080/14796694.2025.2609296.

    PMID: 41524385
  18. 18

    Has PD-1 blockade changed the standard of care for cHL?

    Kuczmarski TM, Lynch RC

    Hematology. American Society of Hematology. Education Program 2024; (2024(1)):505-510 doi:10.1182/hematology.2024000574.

    PMID: 39643988
  19. 19

    Checkpoint Inhibition Therapy in Transplant-Ineligible Relapsed or Refractory Classic Hodgkin Lymphoma.

    Al-Hadidi SA, Lee HJ

    JCO oncology practice 2021; (17(2)):64-71 doi:10.1200/OP.20.00771.

    PMID: 33434064

This page provides educational information about classic Hodgkin Lymphoma diagnosis and treatment. It is for informational purposes only and does not replace professional medical advice from your oncologist.

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