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Health condition · Clinically reviewed

Hodgkin lymphoma, Reed-Sternberg biology, modern chemo-immunotherapy and lifelong survivorship.

A distinct, highly curable lymphoma - defined by Reed-Sternberg cells and a rich inflammatory backdrop, and reshaped in 2024 by nivolumab-AVD.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK haemato-oncology clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSH, NCCN, ESMO and peer-reviewed lymphoma trials you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including BV-AVD, nivolumab-AVD (SWOG S1826) and PET-adapted therapy.

Key facts

Hodgkin lymphoma at a glance.

The essentials in plain English - who it affects, what defines it and how modern UK oncology treats it.

  • What it is

    A distinct lymphoma defined by malignant Reed-Sternberg cells scattered in a rich inflammatory background of normal immune cells.

  • Who it affects

    Bimodal age distribution - peaks in young adults aged 15 to 35 and again after 55. Around 2,000 UK cases each year.

  • Two main types

    Classical Hodgkin lymphoma (about 95%) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) - biologically and therapeutically different.

  • Highly curable

    Overall long-term survival sits around 85%, with early-stage disease approaching 95% cure - one of oncology`s major success stories.

  • Modern first-line

    BV-AVD and, from SWOG S1826 in 2024, nivolumab-AVD are reshaping advanced-stage care, alongside ABVD and escalated BEACOPP in selected patients.

  • Survivorship

    Late effects - cardiac, pulmonary, fertility and second malignancy - now shape the modern treatment ladder as much as cure itself.

Why this guide matters

A curable cancer, treated with restraint.

Hodgkin lymphoma is highly curable - the modern challenge is winning that cure while protecting the heart, the lungs and future fertility.

  • PET-CT drives every decision

    Interim and end-of-treatment PET-CT (Deauville score) guides whether to shorten, escalate or de-escalate therapy in real time.

  • BV-AVD and nivolumab-AVD are here

    ECHELON-1 and, in 2024, SWOG S1826 have shifted advanced-stage first-line care toward chemo-immunotherapy combinations.

  • Survivorship is the long game

    Cardiac, pulmonary, thyroid and second-malignancy surveillance continues for decades after cure - the plan starts on day one.

How the diagnosis is made

From a persistent node to a staged plan.

The route a UK haemato-oncology team follows, in order - so you know what each step is for and why it matters.

  1. 01

    Assessing

    Clinical assessment

    A careful history and examination looking for painless lymphadenopathy, B symptoms and mediastinal features - the classic Hodgkin picture.

  2. 02

    Assessing

    Excisional lymph node biopsy

    The diagnostic gold standard. A whole node is removed and sent for specialist haematopathology - core biopsies alone are often not enough.

  3. 03

    Assessing

    Immunohistochemistry panel

    Reed-Sternberg cells with CD30 and CD15 positivity and variable CD20 confirm classical HL. NLPHL is CD20 positive and CD30 negative.

  4. 04

    Confirming

    PET-CT staging

    Whole-body FDG PET-CT gives the Ann Arbor stage and, later, the Deauville response score. Specialist commissioned imaging.

  5. 05

    Confirming

    Baseline bloods and organ tests

    FBC, LDH, beta-2 microglobulin, ESR, renal and liver profile, plus lung function tests before bleomycin and an ECG or echo before anthracyclines.

  6. 06

    Preparing

    Bone marrow biopsy - selective

    Rarely needed now that PET-CT is standard. Reserved for equivocal marrow findings or specific advanced-stage decisions.

  7. 07

    Preparing

    MDT and fertility referral

    A specialist commissioned haemato-oncology MDT sets the treatment plan. Fertility preservation is discussed with every patient before therapy starts.

Typical timeline: from first biopsy to starting treatment in two to four weeks under a specialist team.

Symptoms

What Hodgkin lymphoma looks like.

A rubbery node in the neck is the classic presentation - but B symptoms, itch and a mediastinal mass tell you just as much.

  • Painless lymphadenopathy

    A firm, rubbery, painless neck, supraclavicular or axillary node is the classic first sign - often noticed in the shower or on shaving.

  • Cervical and supraclavicular nodes

    The cervical chain, especially supraclavicular, is the commonest site. A persistent supraclavicular node in a young adult deserves urgent review.

  • B symptoms

    Unexplained fevers, drenching night sweats and weight loss of more than 10% body weight over six months. Present in around a third at diagnosis.

  • Mediastinal mass

    Common in young women with nodular sclerosis HL. May cause cough, chest ache or, when large, superior vena cava obstruction.

  • Pel-Ebstein fever

    A cyclical fever - days of high temperature alternating with afebrile periods - is uncommon but classical of Hodgkin lymphoma.

  • Generalised pruritus

    Persistent itch without a rash can precede diagnosis by months. In a young adult with itching and lymphadenopathy, think lymphoma.

  • Alcohol-induced nodal pain

    A rare but historically classic feature - nodes ache within minutes of drinking alcohol. Uncommon, but almost specific to Hodgkin.

  • Red flag - SVC obstruction

    Facial swelling, distended neck veins and breathlessness from a large mediastinal mass is an oncological emergency needing same-day assessment.

Treatment

How Hodgkin lymphoma is treated in the UK.

A stage-adapted ladder - ABVD or BV-AVD for early and advanced disease, PET-guided radiotherapy, and salvage transplant or checkpoint immunotherapy at relapse.

  • ABVD chemotherapy

    Doxorubicin, bleomycin, vinblastine and dacarbazine - the long-standing UK backbone for both early and advanced HL, given for 2 to 6 cycles depending on stage.

  • BV-AVD (brentuximab-AVD)

    Brentuximab vedotin added to AVD (bleomycin removed) - the ECHELON-1 regimen improved progression-free survival and is now a preferred advanced-stage option. See our brentuximab lymphoma clinic.

  • Nivolumab-AVD

    Practice-changing SWOG S1826 (2024) showed nivolumab-AVD outperforms BV-AVD in advanced classical HL, with less neuropathy and febrile neutropenia. See our nivolumab clinic.

  • Escalated BEACOPP

    A more intensive regimen used in fit younger patients with advanced high-risk disease - higher cure rates balanced against fertility and secondary malignancy risk.

  • Involved-site radiotherapy

    Focused, low-dose radiotherapy to the original nodal areas, guided by pre-treatment PET-CT. Used in early-stage disease after chemotherapy, PET-adapted where possible.

  • Salvage chemo and auto-SCT

    For relapsed or refractory disease - salvage regimens such as BEAM, ICE or DHAP followed by high-dose therapy and autologous stem cell transplant.

  • Checkpoint inhibitors

    Nivolumab and pembrolizumab exploit PD-1 on Reed-Sternberg cells and are highly active in relapsed HL, alone or with brentuximab. See our checkpoint immunotherapy clinic.

  • CD30 CAR-T and allo-SCT

    For chemo-refractory disease after autologous transplant - CD30-directed CAR-T and, in selected patients, allogeneic stem cell transplant. Specialist commissioned centres only.

What this guide is based on

The sources behind every claim on this page.

UK and international specialist society guidance and practice-changing trials, current at the time of last review.

Key references

Guidelines and trials we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your haemato-oncology team knows your pathology, staging and fitness. If in doubt about symptoms or treatment, contact them directly.

  • British Society for Haematology (BSH). Guidelines for the diagnosis and management of Hodgkin lymphoma.

  • NCCN. Clinical Practice Guidelines in Oncology - Hodgkin Lymphoma.

  • ESMO. Clinical Practice Guidelines for Hodgkin Lymphoma - diagnosis, treatment and follow-up.

  • SWOG S1826 (NEJM, 2024). Nivolumab-AVD versus brentuximab-AVD in advanced Hodgkin lymphoma.

  • ECHELON-1 Trial. Brentuximab vedotin with AVD in advanced classical Hodgkin lymphoma.

Red flags

When Hodgkin lymphoma needs urgent attention.

The situations that mean same-day contact with your oncology team, A and E, or an urgent specialist review.

  • Superior vena cava obstruction

    Facial and neck swelling, distended veins and breathlessness from a bulky mediastinal mass. Requires same-day oncology admission and urgent imaging.

  • Neutropenic sepsis on treatment

    Fever above 38 degrees during chemotherapy is a medical emergency - go straight to your oncology emergency line or A and E and quote your chemotherapy card.

  • New shortness of breath on bleomycin

    Bleomycin-induced pneumonitis can be fatal if missed. Any new cough or breathlessness during ABVD-based therapy needs urgent specialist assessment.

  • Cardiac symptoms after anthracycline

    Doxorubicin can cause cardiomyopathy years later. New breathlessness, ankle swelling or palpitations in a survivor deserves an urgent cardio-oncology review.

  • Second malignancy in survivors

    Long-term risk of breast, thyroid and lung cancer after chest radiotherapy. Regular screening and prompt review of any new lump is essential.

  • Relapse after remission

    New lymphadenopathy, unexplained fevers or B symptoms after treatment need urgent re-staging - salvage therapy works best when started early.

  • Fertility discussion missed

    Every patient of reproductive age should be offered fertility preservation before treatment - if it hasn`t been raised, ask.

  • Psychological distress

    A Hodgkin diagnosis in a young adult carries a heavy emotional load - Lymphoma Action, Blood Cancer UK and specialist psycho-oncology teams can help.

  • HIV or immunosuppression

    HL is more aggressive in HIV positive patients and those on long-term immunosuppression. Combined haematology and HIV care is essential (see our HIV guide).

Living with it

A curable diagnosis, carried for a lifetime.

Four things that shape the years after diagnosis - your team, fertility, long-term follow-up and the community around you.

A quiet reminder

Cure is the beginning of survivorship, not the end.

The best long-term outcomes come from a steady partnership with your haematology, cardio-oncology and primary care teams.

  1. 01 Team

    Lean on your MDT

    A haemato-oncology MDT, clinical nurse specialist and community team should walk you through every step - use them.

  2. 02 Fertility

    Ask about preservation early

    Sperm banking, egg or embryo freezing and ovarian tissue options should be discussed before treatment starts - not after.

  3. 03 Follow-up

    Survivorship is lifelong

    Cardiac, pulmonary, thyroid, breast and second-cancer surveillance continues for decades - keep every follow-up appointment.

  4. 04 Support

    You are not the first

    Lymphoma Action and Blood Cancer UK run peer support, helplines and information services shaped by people who have been where you are.

Frequently asked

Everything we get asked about Hodgkin lymphoma.

Quick answers on diagnosis, chemotherapy regimens, cure rates and long-term follow-up.

  • What is Hodgkin lymphoma?

    Hodgkin lymphoma is a cancer of the lymphatic system defined by malignant Reed-Sternberg cells surrounded by a rich background of normal inflammatory cells. Around 2,000 people are diagnosed in the UK each year, most commonly young adults aged 15 to 35 or people over 55.

  • Is Hodgkin lymphoma curable?

    Yes - Hodgkin lymphoma is one of the most curable cancers. Overall long-term survival is around 85%, and for early-stage disease cure rates approach 95%. Modern regimens such as BV-AVD and nivolumab-AVD, together with PET-adapted therapy, continue to improve outcomes.

  • What is the difference between classical HL and NLPHL?

    Classical HL (about 95% of cases) shows Reed-Sternberg cells that are CD30 and CD15 positive with variable CD20. Nodular lymphocyte-predominant HL is a distinct entity with CD20 positive, CD30 negative popcorn cells - it is often indolent and treated with rituximab-based regimens and radiotherapy.

  • What are B symptoms?

    B symptoms are unexplained fevers, drenching night sweats and weight loss of more than 10% of body weight over six months. They are recorded as part of Ann Arbor staging and, when present, guide both prognosis and intensity of treatment.

  • How is Hodgkin lymphoma diagnosed?

    Diagnosis is made on an excisional lymph node biopsy reviewed by a specialist haematopathologist, with immunohistochemistry confirming Reed-Sternberg cells. Staging uses whole-body PET-CT (Ann Arbor stage and Deauville response), together with baseline bloods, lung function and cardiac tests.

  • What are the long-term effects of treatment?

    Modern treatment aims to cure while minimising late effects, but survivors need lifelong follow-up. Anthracyclines can affect the heart, bleomycin the lungs, and chest radiotherapy carries a long-term risk of breast, thyroid and lung cancers. Fertility preservation is discussed before treatment starts.

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