Intractable Hodgkin Lymphoma; Refractory HL; Refractory Hodgkin Disease; Refractory Hodgkin's Lymphoma; Refractory Hodgkins Lymphoma; Relapsed Hodgkin Lymphoma; Relapsed Hodgkin's Lymphoma; Relapsed Hodgkins Lymphoma; Relapsing Hodgkin's Lymphoma; Relapsing Hodgkins Lymphoma

Refractory Hodgkin Lymphoma (RHL) is a type of cancer affecting the lymphatic system which either does not respond to treatment or recurs within a year of successful treatment.

Patients with RHL will have previously been diagnosed with classical Hodgkin Lymphoma (HL) and received treatment. Cancer that resists treatment (Refractory) or returns following remission (Relapse) is categorized as RHL.

Hodgkin Lymphoma is distinguished from other lymphomas primarily by the presence of giant cells known as Reed-Sternberg cells.

Diagnostic testing: Diagnostic testing for RHL may include:

• •

  Physical examination;

• •

  Lymph node biopsy showing Reed-Sternberg cells;

• •

  Blood tests;

• •

  Bone marrow biopsy or aspiration; and

• •

  Imaging studies as CT, MRI, and positron emission tomography (PET).

Physical findings: Physical symptoms of HL and RHL vary, but commonly include:

• •

  Swollen lymph nodes in the neck, armpit, or groin;

• •

  Discomfort or feeling of fullness in the abdomen;

• •

  Fatigue;

• •

  Shortness of breath; and

• •

  Unexplained fever, night sweats, or weight loss.

ICD-9: 201

ICD-10: C81

The prognosis is poor for HL patients who do not achieve full remission after completing their initial course of treatment, or sustain remission for one year. Approximately 1 in 4 HL diagnoses progress to RHL.

Treatment of RHL typically consists of salvage chemotherapy, followed by autologous stem cell transplant. The approach to treatment may vary depending on the timing of the relapse, age of individual, general health of the individual, and previous responses to treatment.

Suggested MER for Evaluation:

• •

  Clinical history confirming diagnosis of Hodgkin Lymphoma, and documenting unsuccessful treatment or relapse within one year of completing initial treatment.

Suggested Listings for Evaluation:

REMARKS

RHL, by definition, meets 13.05 B. Most RHL patients will also meet 13.05 C.