Hodgkin’s Lymphoma: Pathogenesis, Risk Factors, and Biological Behaviour in Contemporary Clinical Practice

Abstract

Hodgkin’s lymphoma (HL) represents a unique and enigmatic malignancy within the spectrum of lymphoid neoplasms, characterised by the presence of distinctive Reed-Sternberg cells within a complex inflammatory microenvironment. This comprehensive review examines the current understanding of HL pathogenesis, encompassing both Epstein-Barr virus (EBV)-positive and EBV-negative disease mechanisms.

Background: The biological behaviour of HL is distinguished by its bimodal age distribution, characteristic pattern of contiguous lymph node spread, and remarkable responsiveness to therapeutic intervention, with cure rates approaching 95% in contemporary practice.

Methods: Recent advances in molecular biology have elucidated the critical role of constitutive NF-κB and JAK/STAT pathway activation in disease pathogenesis, alongside sophisticated immune evasion mechanisms.

Results: The tumour microenvironment in HL demonstrates unique characteristics, with malignant Hodgkin and Reed-Sternberg cells comprising less than 5% of the cellular population whilst orchestrating a complex milieu of reactive inflammatory cells.