What is the current staging for a patient with intermediate-stage unfavorable Hodgkin's lymphoma after completing 4 cycles of ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) chemotherapy and 30 Gy involved-field radiotherapy with a negative PET-CT scan?

Staging After Treatment Completion for Intermediate-Stage Unfavorable Hodgkin's Lymphoma

Direct Answer

This patient has achieved complete metabolic remission and should be classified as having no evidence of disease (NED) or complete response (CR) status after completing standard-of-care therapy for intermediate-stage unfavorable Hodgkin's lymphoma. 1

Understanding the Treatment Context

Your patient received the guideline-concordant regimen for intermediate-stage unfavorable disease:

• 4 cycles of ABVD followed by 30 Gy involved-field radiotherapy represents the established standard of care for this disease stage 1
• The negative PET-CT scan indicates complete metabolic response, which is the optimal treatment outcome 1

Current Disease Status Classification

The patient's current staging should be documented as:

• Complete metabolic response (CMR) with Deauville score ≤3 based on the negative PET-CT 1
• No evidence of active disease following completion of planned therapy 1
• The original Ann Arbor stage (which defined them as intermediate-stage unfavorable) remains their baseline staging for historical reference, but their current status is complete remission 1

Prognostic Implications

Patients achieving negative PET-CT after completing 4 cycles of ABVD plus 30 Gy radiotherapy have excellent outcomes:

• 5-year progression-free survival exceeds 90% with combined modality therapy in this population 2
• Complete response rates of 82-94% are expected with this treatment approach 2, 3
• Negative interim PET (Deauville ≤2-3) strongly predicts favorable long-term outcomes, with 91% 3-year event-free survival and 95% 3-year overall survival 4

Critical Distinction: Staging vs. Response Assessment

It is essential to distinguish between initial staging and post-treatment response status:

• Initial staging (Ann Arbor classification with risk factors) determines treatment selection and remains the historical baseline 1
• Post-treatment response assessment (via PET-CT with Deauville scoring) determines current disease status and prognosis 1
• This patient's intermediate-stage unfavorable designation was their pre-treatment classification; they are now in complete remission 1

Common Pitfall to Avoid

Do not confuse the patient's original stage with their current disease status. The intermediate-stage unfavorable classification guided treatment selection, but after completing therapy with negative PET-CT, the patient should be documented as having achieved complete metabolic response, not as still having "intermediate-stage disease" 1. This distinction is critical for surveillance planning and prognostic counseling.

Surveillance Recommendations

Following complete response, patients enter surveillance rather than active treatment:

• Regular clinical follow-up with history and physical examination is indicated 1
• The frequency and modality of surveillance imaging should follow institutional or guideline-based protocols for patients in remission 1
• The negative end-of-treatment PET-CT serves as the new baseline for comparison during surveillance 1