B Symptoms in Hodgkin Lymphoma

Definition and Classification

The term "B symptoms" originates from the Ann Arbor staging classification system for Hodgkin lymphoma, where the letter "B" designates the presence of specific constitutional symptoms, distinguishing these patients from those with "A" designation who lack such symptoms 1, 2, 3
The "B" suffix is used to indicate the presence of at least one of the three cardinal constitutional symptoms, which include unexplained weight loss, recurrent unexplained fever, and recurrent drenching night sweats 1, 2, 3

The presence of B symptoms indicates more aggressive disease behavior and worse outcomes, and is used to capture prognostic information in the staging nomenclature 5, 6
The B suffix fundamentally alters risk stratification and treatment intensity, with patients with early-stage disease being reclassified from "early favorable" to "early unfavorable" when B symptoms are present 5, 6

The three cardinal B symptoms are: unexplained weight loss >10% of baseline body weight during the 6 months prior to staging, recurrent unexplained fever >38°C, and recurrent drenching night sweats 1, 6
In immunocompromised patients, particularly those with HIV, B symptoms must be distinguished from infectious etiologies, and an infectious disease workup should be performed to avoid misattribution 6

The Lugano classification (2014) specifies that A/B suffixes should only be included for Hodgkin lymphoma staging, not for non-Hodgkin lymphoma, emphasizing the historical and prognostic specificity of this nomenclature to HL 4, 5