Internal medicine

Pathology

Tumor microenvironment

Lymphocyte

Lymphoma

Oncology

Immunology

Chemotherapy

Nodular sclerosis

Brentuximab vedotin

Lymph node

Hodgkin lymphoma

Cancer research

CD30

Medicine

Immune system

Nature Reviews Disease Primers

Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few malignant cells and numerous immune effector cells in the tumour microenvironment. The incidence of HL is highest in adolescents and young adults, although HL can affect elderly individuals. Diagnosis is based on histological and immunohistochemical analyses of tissue from a lymph node biopsy; the tissue morphology and antigen expression profile enable classification into one of the four types of classic HL (nodular sclerosis, mixed cellularity, lymphocyte-depleted or lymphocyte-rich HL), which account for the majority of cases, or nodular lymphocyte-predominant HL. Although uncommon, HL remains a crucial test case for progress in cancer treatment. HL was among the first systemic neoplasms shown to be curable with radiation therapy and multiagent chemotherapy. The goal of multimodality therapy is to minimize lifelong residual treatment-associated toxicity while maintaining high levels of effectiveness. Recurrent or refractory disease can be effectively treated or cured with high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and prospective trials have demonstrated the potency of immunotherapeutic approaches with antibody–drug conjugates and immune checkpoint inhibitors. This Primer explores the wealth of information that has been assembled to understand HL; these updated observations verify that HL investigation and treatment remain at the leading edge of oncological research. Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few, large, multinucleated malignant cells in the tumour microenvironment, which is rich in normal immune effector cells. HL mostly occurs in young adults and has high cure rates.