What are the treatment options for Hodgkin's lymphoma (Hodgkin disease)?

From the Guidelines

The treatment for Hodgkin lymphoma typically involves chemotherapy, radiation therapy, or a combination of both, depending on the disease stage and patient factors, with the standard approach being 2-4 cycles of ABVD chemotherapy followed by involved-field radiation therapy for early-stage disease and 6 cycles of ABVD for advanced disease. For early-stage Hodgkin lymphoma (stages I-II), the standard approach is 2-4 cycles of ABVD chemotherapy (Adriamycin/doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) followed by involved-field radiation therapy, as shown in studies such as 1. Some key points to consider in the treatment of Hodgkin lymphoma include:

• The use of ABVD chemotherapy, which has been shown to be effective in treating Hodgkin lymphoma, with a long-term cure rate of 50-60% for advanced disease, as noted in 1.
• The role of radiation therapy, which can be used in combination with chemotherapy or as a standalone treatment, depending on the disease stage and patient factors, as discussed in 1.
• The importance of PET-CT scans in assessing treatment response and guiding further therapy, as mentioned in 1.
• The potential for relapse, which can be treated with salvage chemotherapy and autologous stem cell transplantation, as outlined in 1. It's worth noting that the treatment of Hodgkin lymphoma is constantly evolving, with new therapies and approaches being developed, such as brentuximab vedotin and immune checkpoint inhibitors, which may offer improved outcomes for patients, as discussed in 1.

From the FDA Drug Label

INDICATIONS AND USAGE ADCETRIS is a CD30-directed antibody and microtubule inhibitor conjugate indicated for treatment of: • Adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine (1. 1). • Adult patients with classical Hodgkin lymphoma (cHL) at high risk of relapse or progression as post-autologous hematopoietic stem cell transplantation (auto-HSCT) consolidation (1. 3). • Adult patients with classical Hodgkin lymphoma (cHL) after failure of auto-HSCT or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not auto-HSCT candidates (1. 4).

INDICATIONS AND USAGE: Vinblastine Sulfate Injection is indicated in the palliative treatment of the following: I Frequently Responsive Malignancies Generalized Hodgkin’s disease (Stages III and IV, Ann Arbor modification of Rye staging system)

Hodgkin Treatment:

• Brentuximab vedotin (IV) is indicated for the treatment of adult patients with previously untreated Stage III or IV classical Hodgkin lymphoma (cHL), in combination with doxorubicin, vinblastine, and dacarbazine 2.
• Vinblastine (IV) is indicated in the palliative treatment of generalized Hodgkin’s disease (Stages III and IV, Ann Arbor modification of Rye staging system) 3.
• Key points for treatment include:
  • Combination therapy with multiple agents
  • Different dose-limiting clinical toxicities and mechanisms of action
  • Vinblastine sulfate is effective as a single agent, but usually administered in combination with other antineoplastic drugs
  • Brentuximab vedotin (IV) is used in combination with chemotherapy for adult patients with previously untreated Stage III or IV cHL.

From the Research

Treatment Options for Hodgkin Lymphoma

• The most effective treatment program for early-stage Hodgkin lymphoma is chemotherapy, most commonly ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), followed by consolidation radiation therapy 4.
• Advanced stages of classical Hodgkin lymphoma can be cured by first-line treatment in 80% of patients, with conventional treatment options including ABVD chemotherapy or escalated BEACOPP 5.
• The combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is the most commonly used chemotherapy regimen in North America for the treatment of advanced-stage Hodgkin's lymphoma 6.

Chemotherapy Regimens

• ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) continues to be the standard of care for patients with advanced-stage Hodgkin lymphoma (HL) 7.
• Escalated BEACOPP has more acute and late toxicities, and survival benefits have yet to be confirmed 7.
• The addition of interferon-α (IFN-α) to standard ABVD chemotherapy (IABVD) has been shown to be an effective treatment for patients with newly diagnosed advanced stage classic Hodgkin lymphoma 8.

Treatment Outcomes

• The 3-year event-free survival rate for patients treated with IABVD was 71%, and the 3-year overall survival rate was 96% 8.
• Consolidation of primary chemotherapy with radiation or autologous stem cell transplantation (ASCT) has not demonstrated an improvement in overall survival in randomized controlled trials 7.
• ASCT has become the standard of care for patients with relapsed or refractory HL based on two randomized trials 7.