ESMO guidelines for the treatment of Hodgkin lymphoma

This study outlines the ESMO guidelines for the diagnosis, treatment and follow-up of Hodgkin lymphoma.

Hodgkin lymphoma is a cancer of the lymph system. It mostly occurs in young adults, but can also occur in adults over the age of 55. The European Society for Medical Oncology (ESMO) has recently updated their guidelines for the diagnosis and treatment of all stages of the disease.

The current article outlines the treatment recommendations of the ESMO for Hodgkin lymphoma.

To accurately stage Hodgkin lymphoma, patients should undergo a chest x-ray, CT scan, and PET scan. A PET scan uses a radioactive substance to image the organs and tissues. Heart and lung function should be measured. Patients who undergo a PET-CT scan can generally avoid a bone marrow biopsy. Patients should be given reproductive counseling, as many treatments can cause fertility damage.

The standard treatment for favorable (without risk factors) early-stage Hodgkin lymphoma is 2 or 3 cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine). This is followed by 20 Gy (dose measure) of radiation to the involved area.

Patients with other risk factors (such as a large chest tumor or other symptoms) have unfavorable disease. Treatment with 4 cycles of ABVD and 30 Gy of radiation is recommended. A recent trial showed that 2 cycles of another chemotherapy, escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), followed by 2 cycles of ABVD and radiation was also effective.

Treatment options are different for advanced disease. Patients under the age of 60 are recommended to be treated with 6 to 8 cycles of ABVD followed by radiation of any cancer remaining. Another option is 6 cycles of escalated BEACOPP followed by radiation to sites still positive for cancer on a PET scan. An analysis of multiple studies found a 10% advantage in survival at 5 years for this treatment. Patients over 60 should not be treated with BEACOPP. It has been found to increase treatment-related death in older patients. It is recommended that older patients be treated with ABVD.

In patients that have relapsed, high-dose chemotherapy followed by stem cell transplantation is recommended. Salvage chemotherapy should be delivered before the high-dose chemotherapy to try to shrink the tumor. Recommended chemotherapies include IGEV (ifosfamide, gemcitabine, and vinorelbine) or ICE (ifosfamide, carboplatin, and etoposide). Brentuximab vedotin (Adcetris) has shown a 75% response rate in pretreated patients, and could be considered.

Following treatment, patients should be followed every three months for the first six months, every 6 months for the next four years, and yearly after that. Patients should be watched for second cancers, thyroid problems, and heart or lung problems.

This study outlined the European Society for Medical Oncology treatment recommendations for Hodgkin lymphoma.