From the Guidelines
The standard chemotherapy regimen for Hodgkin's lymphoma is ABVD, which consists of Adriamycin (doxorubicin) 25 mg/m², bleomycin 10 units/m², vinblastine 6 mg/m², and dacarbazine 375 mg/m², administered intravenously on days 1 and 15 of a 28-day cycle. This regimen is preferred for Hodgkin's lymphoma because it targets the specific biology of Reed-Sternberg cells and has shown superior efficacy with manageable toxicity profiles 1. The total number of cycles determined by the disease stage and response to treatment, with 2-4 cycles sufficient for early-stage favorable disease, and 6 cycles usually required for advanced disease 1.
Key Considerations
- For early-stage favorable disease, 2-4 cycles of ABVD may be sufficient, followed by 30 Gy involved field (IF) radiotherapy 1.
- For early unfavorable disease, four cycles of ABVD followed by 30 Gy IF radiotherapy is the standard of care, resulting in tumor control and overall survival in excess of 85% or 90% at 5 years 1.
- For advanced-stage disease, ABVD is currently being used in many countries, but the introduction of BEACOPP escalated has resulted in superior overall response, disease-free, and overall survival at 5 years 1.
- Patients should be monitored for pulmonary toxicity from bleomycin, cardiac effects from doxorubicin, and peripheral neuropathy from vinblastine during treatment.
Disease-Specific Treatment
- Lymphocyte predominant Hodgkin’s lymphoma (LPHL) presents more often in early stages with an indolent course but a tendency to recur, and can be treated with IF radiotherapy (30 Gy) only for stage I patients, with rituximab as an option for relapsed LPHL 1.
- Younger patients relapsing after prior combined modality treatment should receive high-dose chemotherapy (HDCT) and autologous stem-cell transplantation, with salvage regimens including DHAP, ESHAP, ICE, MiniBEAM or gemcitabine combinations 1.
From the FDA Drug Label
Vinblastine sulfate has been shown to be one of the most effective single agents for the treatment of Hodgkin’s disease Advanced Hodgkin’s disease has also been successfully treated with several multiple-drug regimens that included vinblastine sulfate. Patients who had relapses after treatment with the MOPP program— mechlorethamine hydrochloride (nitrogen mustard), vincristine sulfate, prednisone and procarbazine—have likewise responded to combination-drug therapy that included vinblastine sulfate A protocol using cyclophosphamide in place of nitrogen mustard and vinblastine sulfate instead of vincristine sulfate is an alternative therapy for previously untreated patients with advanced Hodgkin’s disease
The chemotherapy regimen for Hodgkin's lymphoma includes:
- MOPP program: mechlorethamine hydrochloride (nitrogen mustard), vincristine sulfate, prednisone, and procarbazine
- An alternative protocol using cyclophosphamide in place of nitrogen mustard and vinblastine sulfate instead of vincristine sulfate 2 Note that vinblastine sulfate can be used as a single agent, but combination therapy is generally more effective.
From the Research
Chemotherapy Regimens for Hodgkin's Lymphoma
The chemotherapy regimens for Hodgkin's lymphoma include:
- ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) 3, 4, 5, 6, 7
- BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) 3, 6, 7
- Stanford V (vinblastine, doxorubicin, vincristine, bleomycin, mustard, etoposide, and prednisone) 6
- COPP/ABVD or MOPP/ABVD (hybrid or alternating chemotherapy regimens with ABVD as the backbone) 3
- Cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP) 3
Treatment Strategies
The treatment strategies for Hodgkin's lymphoma depend on the stage and risk profile of the patient:
- For advanced-stage Hodgkin's lymphoma, six cycles of BEACOPPescalated have been shown to improve overall survival compared to ABVD 3
- For nonbulky early-stage Hodgkin's lymphoma, four to six cycles of ABVD are recommended, with fewer cycles given to those with an early complete remission 4
- For bulky early-stage Hodgkin's lymphoma, combined-modality therapy with ABVD and radiotherapy is the standard of care 4
- For relapsed or refractory Hodgkin's lymphoma, autologous stem cell transplantation (ASCT) has become the standard of care 5