Introduction

Hodgkin disease/lymphoma is a malignancy with deep-rooted history. Thomas Hodgkin described the clinical history and post-mortem findings of lymphadenopathy and splenomegaly in six patients in 1832. In 1865, Sir Samuel Wilks published a second paper entitled “Cases of the enlargement of the lymphatic glands and spleen (or Hodgkin's disease) with remarks.” In that report, Wilks described a disease that may remain in the lymph nodes for years and is associated with anemia, fevers, and weight loss. Over the next 30 years, several physicians (W. S. Greenfield 1878, Carl Sternberg 1879, and Dorothy Reed 1902) provided the first pathologic descriptions of the characteristic malignant cells. Physicians initially believed that Hodgkin disease was caused by an infection, such as tuberculosis. Despite studies in the early twentieth century confirming the malignant nature of this disease, it has only been in the last 10–15 years that the malignant cells were shown to be derived from clonal B cells, hence the current World Health Organization (WHO) designation as “Hodgkin lymphoma.”

Prior to the 1960s, patients with advanced-stage Hodgkin lymphoma were typically treated with single-agent chemotherapy, resulting in a median survival of approximately 1 year and 5-year overall survival (OS) of < 5%. Major success in Hodgkin lymphoma has been achieved by radiation treatment and moreover by the development of multi-agent poly-chemotherapy. In 1950, Peters reported 70–80% 10-year OS rates for patients with stage I disease treated with high-dose, fractionated radiation therapy (RT).