In total, 24 records were included. HL accounted for 18.1% of lymphoid neoplasms (24/132) and 3.8% of malignant hematologic disorders (24/748) during the study period. The annual incidence was 1.5. The mean age of patients was 38.7 years (12-63), with a male predominance and a sex ratio of 1.7. Figure 1 describes the distribution of patients by age group.

The main presenting circumstance of Hodgkin's lymphoma (HL) was lymph node enlargement, present in all patients (100%). Patients also exhibited night sweats (6/24), prolonged fever (6/24), fatigue (1/24), and persistent pruritus (1/24). Physical signs were predominantly characterized by lymph node enlargement, averaging 7cm (range 2-15). These were peripheral in 21 patients and cervical in 17. A quarter of the patients also presented with hepatomegaly, and four had splenomegaly.

Histologically, classical HL constituted most histological types, diagnosed in 21 (87.5%) patients. Table 1 illustrates the distribution of patients based on histology.

Sixteen patients underwent staging (66.7%). Among these patients, five (33.3%) were at an early stage at diagnosis, with two patients presenting a bulky mass, and eleven (67.7%) were at an advanced stage (Figure 2). Adverse prognosis was observed in 37.5% of these patients (Table 2). Thirty-seven-point five percent (37.5%) of the included patients exhibited clinical signs of progression, and fifty-four percent (54%) showed biological signs of progression.

In terms of treatment, the frontline protocol used was the combination chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Thirteen patients, accounting for a ratio of 54.2%, initiated this treatment. They received between 1 and 6 cycles. Table 3 presents the outcomes of patients diagnosed with HL at the time of our study.

In comparison to other malignant hematologic disorders, Hodgkin's lymphoma is relatively rare, as demonstrated by the prevalence found in our study. With approximately 1,500 new cases per year in France, Hodgkin's lymphoma accounts for only 10 to 15% of lymphomas and 0.5 to 1% of new cancer cases 10. In the United States, it represents 10% of all lymphomas 11. In Togo, although the incidence of Hodgkin's lymphoma is low, it is on the rise. While it was 0.65 new cases per year in a study conducted over a 20-year period by Padaro et al. 6, it is currently at 1.5. This increase could be attributed to an improvement in technical facilities and an increase in the number of pathologists, making diagnosis more accessible. Hodgkin's lymphoma exhibits a bimodal distribution, with an initial peak in young adults (20-30 years) and a second peak in individuals over 60 years old 12. This bimodal incidence suggests that this pathology may stem from two distinct pathogenic processes: an infectious agent for young adults (EBV: Epstein Barr Virus) and a mechanism shared with other lymphomas for older patients 1314. In developing countries, Hodgkin's lymphoma predominantly affects a younger population. The average age of patients in our study aligns with this data, as do the findings of other sub-Saharan studies 1516. Hodgkin's lymphoma can also occur in children and adolescents, but it is rare before the age of 5 12. In our study, the low proportion of children found is explained by the fact that the hematology department at CHU Campus primarily receives adults. Male predominance has also been noted in previous series 111718.

All patients presented with lymph node enlargement, predominantly peripheral and cervical. Indeed, at the time of diagnosis, most Hodgkin's lymphoma patients present with supradiaphragmatic lymphadenopathy. Patients frequently exhibit involvement of cervical, anterior mediastinal, supraclavicular, and axillary lymph nodes, while inguinal regions are less commonly affected. About a third of patients present systemic symptoms such as fever, night sweats, and weight loss 19.

Classical HL is the most found subtype, accounting for nearly 90% of HL cases 171819. The results of our study align with this.

Only 16 patients (66.67%) underwent staging. This is mostly due to the patients' low socioeconomic status. Undergoing a scan cost approximately $133 USD, approximately 2.3 times the minimum wage during the study period ($58 USD). Long delays in specialized consultations, associated with diagnostic errors, and the difficulty in accessing the country's only public clinical hematology service account for the prevalence of advanced stages and poor prognoses in our study.

The indicated first-line treatment in our study was the ABVD protocol with six cycles, due to the unavailability of PET-CT at CHU and radiotherapy, which could have reduced the number of chemotherapy cycles based on the therapeutic response to systemic treatment. Only one patient achieved complete remission, and 17 (71%) were lost to follow-up. This high rate of loss to follow-up and low rate of remission reflects the financial precariousness of patients, most of whom did not initiate or complete the treatment. Indeed, Hodgkin's lymphoma is a highly curable hematologic malignancy, and the ABVD protocol is a validated treatment supported by several studies. It is used in combined therapy with radiotherapy or as a single modality due to the late toxicity of radiotherapy 202122. The BEACOPP protocol is another effective therapeutic alternative for advanced stages. However, it is more toxic, requiring additional supportive care and closer monitoring of hematological parameters 232425, making it unfeasible in our practice setting. Therefore, therapeutic strategy in Hodgkin's lymphoma relies on effective risk stratification based not only on the Ann Arbor classification but also on certain prognostic factors 719. Beyond the historical classifications of EORTC for limited stages and IPS for advanced stages 89, which have long guided therapeutic choices, PET-CT has proven useful both in diagnostic performance 26272829 and in treatment 3031, leading to a modification in the therapeutic approach based on the response according to interim PET-CT after two cycles of chemotherapy. It is nowadays an indispensable tool for the effective management of Hodgkin's lymphoma.