ESMO guidelines for the treatment of Hodgkin’s lymphoma

This article provided the ESMO guidelines for the treatment of Hodgkin’s lymphoma (HL).

Hodgkin’s lymphoma (HL) comprises 10% of new lymphoma cases in the U.S., with 21% of these occurring in adolescents. Thanks to advancements in treatment, mortality rates have decreased dramatically. 90% of patients with HL will be long-term survivors.

Classical HL (cHL) and nodular lymphocyte-predominant HL (NLPHL) are the two main subtypes of HL. Chemotherapy and radiation are the foundations of treatment for cHL. PET scans after 1 or 2 cycles of treatment (interim PET) may be used to determine future treatment intensity.

The European Society for Medical Oncology (ESMO) has recently updated their guidelines for the diagnosis and treatment of all stages of the disease.

For patients with early-stage cHL, 2 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by radiation therapy is the main standard of care. Interim PET may be used after chemotherapy to guide further treatment. If residual cancer is detected (positive PET scan), additional chemotherapy and radiation therapy may be recommended. High-dose BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) may also be used.

For patients with intermediate-stage cHL, 4 cycles of ABVD chemotherapy followed by radiation therapy is considered the main standard of care. More intense treatment can be used for certain young patients. This can include high-dose BEACOPP followed by ABVD and radiation therapy.

For patients with advanced-stage cHL, ABVD or high-dose BEACOPP chemotherapy alone are recommended. Radiotherapy is further recommended for patients with residual disease after chemotherapy. In patients older than 60, bleomycin (Blenoxane) should be omitted from the ABVD regimen due to side effects. Also, high-dose BEACOPP should not be used in these patients.

For patients with relapsed (cancer recurrence) or refractory (does not respond to treatment) cHL, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the treatment of choice. Before this approach is used, salvage chemotherapy may be needed to get rid of any remaining cancer cells before ASCT. For patients who fail ASCT, brentuximab vedotin (Adcetris) may be used. This agent is a monoclonal antibody. It specifically targets cancer cells, leading to cancer cell death.

For patients with multiple relapses, nivolumab (Opdivo) and pembrolizumab (Keytruda) are one treatment option. Similar to brentuximab vedotin, these agents are also monoclonal antibodies.

In NLPHL, treatment options depend on disease stage. In early-stage disease, radiation therapy is recommended. For all other stages, NLPHL is treated similarly to cHL. For patients who relapse, biological therapy such as rituximab (Rituxan) or ofatumumab (Arzerra) may be used.

This article provided recommendations for the treatment of classical HL from the European Society for Medical Oncology (ESMO). Treatment options for NLPHL were also discussed.