From the Guidelines
Hodgkin lymphoma patients should be treated with chemotherapy or combined modality therapy, followed by restaging with PET/CT to assess treatment response using the Deauville criteria, as this approach has been shown to be effective in achieving long-term remission and reducing morbidity and mortality. The disease is characterized by the presence of Reed-Sternberg cells, large abnormal lymphocytes that can be seen under a microscope, and typically starts in lymph nodes in the neck, chest, or underarms, with symptoms including painless swelling of lymph nodes, persistent fever, night sweats, unexplained weight loss, and itching 1.
Treatment Options
- Chemotherapy regimens like ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) given every 2 weeks for 2-8 cycles are commonly used, sometimes combined with radiation therapy for early-stage disease 1.
- Advanced cases may require more intensive chemotherapy like BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine, Prednisone).
- PET scans are used to monitor treatment response, and therapy may be adjusted based on interim results.
- High-dose chemotherapy followed by autologous stem cell rescue or transplant (HDT/ASCR) is the standard treatment option for chemosensitive patients with relapsed or refractory (R/R) HL 1.
Prognosis and Long-term Monitoring
- Hodgkin lymphoma has excellent cure rates, with over 90% of patients with early-stage disease and 70-80% with advanced disease achieving long-term remission 1.
- Survivors require long-term monitoring for late effects of treatment including secondary cancers and heart disease.
- The potential long-term effects of treatment remain an important consideration, and long-term follow-up is essential after completion of treatment 1.
From the Research
Treatment Options for Hodgkin Lymphoma
- The treatment of Hodgkin lymphoma depends on the stage and severity of the disease, with various chemotherapy regimens available, including ABVD, BEACOPP, and Stanford V 2, 3, 4, 5.
- ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is a commonly used chemotherapy regimen for advanced-stage Hodgkin lymphoma, with a cure rate of 60-70% for stages III and IV 5.
- BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) is another chemotherapy regimen that has shown promising results, with a 5-year survival rate of 95% for six cycles of BEACOPPescalated 2.
- Brentuximab vedotin, an anti-CD30 antibody-drug conjugate, has been approved for relapsed and refractory Hodgkin lymphoma and has shown superior efficacy to ABVD in the treatment of patients with advanced-stage Hodgkin's lymphoma 6.
Efficacy and Safety of Treatment Options
- A study comparing ABVD and BEACOPP found that six cycles of BEACOPPescalated significantly improved overall survival compared to ABVD, with a 7% survival benefit at 5 years 2.
- Another study found that brentuximab vedotin with chemotherapy (A+AVD) had superior efficacy to ABVD, with a 4.9 percentage-point lower combined risk of progression, death, or noncomplete response and use of subsequent anticancer therapy at 2 years 6.
- The safety profiles of these treatment options vary, with neutropenia and peripheral neuropathy being common side effects of A+AVD, and pulmonary toxicity being a concern with ABVD 6.
Current Recommendations and Ongoing Research
- The current standard of care for patients with advanced-stage Hodgkin lymphoma is ABVD or escalated BEACOPP, with brentuximab vedotin being considered for patients with relapsed or refractory disease 3, 4.
- Ongoing research is focused on optimizing treatment strategies, including the use of interim positron emission tomography to adjust treatment intensity and the development of new chemotherapy regimens and targeted therapies 3, 6.