From the Guidelines
The initial approach to treating Hodgkin lymphoma with lung findings typically involves combination chemotherapy, specifically the ABVD regimen (Adriamycin/doxorubicin, Bleomycin, Vinblastine, and Dacarbazine), followed by consolidative radiation therapy to residual sites if necessary. This regimen is administered intravenously every 2 weeks for 2-8 cycles, depending on disease stage and response. For patients with lung involvement, which indicates at least stage II disease, treatment usually requires 4-6 cycles of chemotherapy 1. PET-CT scanning is performed after 2 cycles to assess early response, which guides subsequent treatment decisions. If the interim PET scan shows good response, bleomycin may be omitted from later cycles (converting to AVD) to reduce pulmonary toxicity, which is particularly important in patients with pre-existing lung involvement 1.
Key Considerations
- The ABVD regimen is the standard of care for Hodgkin lymphoma with lung findings, due to its high efficacy and relatively low toxicity compared to other regimens 1.
- The number of cycles and the need for consolidative radiation therapy depend on the disease stage, response to chemotherapy, and the presence of residual disease 1.
- PET-CT scanning is a crucial tool for assessing early response and guiding treatment decisions, allowing for the omission of bleomycin in later cycles if the response is good, to minimize pulmonary toxicity 1.
- For advanced disease with lung findings, consolidative radiation therapy to residual sites may follow chemotherapy, targeting both systemic disease and local tumor burden 1.
Treatment Approach
- Initiate treatment promptly after diagnosis and staging, as Hodgkin lymphoma with organ involvement can progress rapidly if left untreated.
- Administer the ABVD regimen intravenously every 2 weeks for 2-8 cycles, depending on disease stage and response.
- Perform PET-CT scanning after 2 cycles to assess early response and guide subsequent treatment decisions.
- Consider consolidative radiation therapy to residual sites if necessary, based on the disease stage and response to chemotherapy.
From the Research
Initial Approach to Treating Hodgkin's Lymphoma with Lung Findings
The initial approach to treating Hodgkin's lymphoma with lung findings involves a combination of chemotherapy, radiation therapy, and other treatments.
- The choice of treatment depends on the stage of the disease, the presence of prognostic factors, and the histologic characteristics of the disease 2, 3, 4.
- For patients with early-stage Hodgkin's lymphoma, combined-modality therapies that include abbreviated courses of chemotherapy followed by involved-field radiation treatment are commonly used 2, 3, 4.
- For patients with advanced-stage Hodgkin's lymphoma, a more prolonged course of combination chemotherapy is often used, with radiation therapy used only in selected cases 2, 3, 4.
- Chemotherapy regimens such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) are commonly used to treat Hodgkin's lymphoma, and may be combined with other agents such as brentuximab vedotin and anti-PD-1 antibodies 5, 3, 4.
- High-dose chemotherapy followed by an autologous stem cell transplant is the standard of care for most patients who relapse following initial therapy 2, 3, 4.
Treatment Options for Relapsed or Refractory Disease
For patients with relapsed or refractory Hodgkin's lymphoma, several treatment options are available, including:
- Salvage chemotherapy followed by high-dose treatment and an autologous stem cell transplant 2, 3, 4.
- Brentuximab vedotin, which is a standard approach for patients who are ineligible for autologous stem cell transplant or those in whom high-dose therapy and autologous stem cell transplant have failed 2, 3, 4.
- PD-1 blockade, non-myeloablative allogeneic transplant, or participation in a clinical trial testing novel agents 3, 4.
Lung Findings in Hodgkin's Lymphoma
Lung findings in Hodgkin's lymphoma can include pulmonary involvement, which may be detected by imaging studies such as positron emission tomography (PET) or computed tomography (CT) scans 5.