Guidelines for the treatment of patients with Hodgkin’s lymphoma

This article outlined recommended treatments for patients with Hodgkin's lymphoma (HL).

HL is a type of blood cancer of the lymphatic system. HL can be classified in different ways. In limited HL, cancer is found in one or two sites in the lymphatic system. In advanced HL, cancer is found on both sides of the body or in other organs. Favorable HL requires less intensive treatment, while unfavorable HL is advanced disease that requires more intensive treatment.

Treatment for HL can involve chemotherapy, radiotherapy, or both. Combinations of chemotherapy drugs are also common. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) is one such regimen. This article reviewed different treatment options for patients with HL.

For patients with limited HL, 2 to 6 cycles of ABVD chemotherapy followed by radiotherapy is recommended. For patients with small tumors, ABVD only is recommended. For patients with favorable disease, 2 cycles of ABVD and radiotherapy are recommended. Limiting the number of chemotherapy cycles or omitting radiotherapy can help reduce side effects for these patients.

For patients with unfavorable HL, 4 cycles of ABVD and radiotherapy are recommended. For patients with nodular lymphocyte-predominant HL (NLPHL), radiotherapy only is recommended. NLPHL is a rare but less aggressive type of HL, so less intensive treatment may be used.

ABVD is also a standard regimen for patients with advanced HL. 6 to 8 cycles are recommended for these patients. Some studies showed that PET or CT scanning during treatment could help determine how well treatment is working. This allows for treatment adjustments for patients who are not responding. 

After chemotherapy, patients with advanced HL may undergo further treatment if needed. Radiotherapy may be useful for patients who have tumor shrinkage. For patients who are 65 or younger whose cancer returns, chemotherapy followed by a stem cell transplant is recommended.

Research suggests that biological drugs may improve results for patients with advanced HL that has come back or stopped responding to treatment. Brentuximab vedotin (Adcetris) is a biological drug that targets HL cancer cells while leaving healthy cells alone. Anti-PD-1 antibodies are another option. This type of biological drug helps activate the body's immune system against cancer cells.

This article outlined recommended treatments for patients with HL. Treatment often depends on the type and stage of HL. Emerging treatments may help improve patient outcomes.