NCCN guidelines for the treatment for patients with classical Hodgkin lymphoma

This article outlined the current guidelines for treatment for patients with classical Hodgkin lymphoma (cHL).

Treatments for patients with cHL have advanced in the last number of years and most patients can be cured. Treatment options include chemotherapy (CT), radiotherapy (RT), and biological therapies. Treatment options differ for patients based on the stage of cHL, and risk factors such as older age and the presence of other health conditions. 

Often patients are scanned using PET scans during treatment to see how well it is working. This allows treatments to be changed to suit each patient. An understanding of the best and most recent treatment options for different patients is useful.

Patients with early (stage I or II) cHL with no risk factors or bulky tumors are recommended to receive 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) chemotherapy followed by a PET scan. If there are still signs of cancer, patients may be offered RT or 2 more cycles of ABVD. Patients may also be offered escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) CT.

For patients with early cHL with no bulky tumors but some risk factors, patients should be given ABVD followed by PET scanning. If there is little or no sign of cancer, patients should be given 2 more ABVD cycles and RT. If there is evidence of cancer, patients may be given 2 more cycles of ABVD or BEACOPP with RT. 

For patients with early cHL with bulky tumors and risk factors, patients should be given 2 cycles of ABVD followed by PET scanning. Patients may be offered 2 or 4 more cycles of ABVD with or without RT, or 2 to 3 cycles of BEACOPP.

For patients with advanced (stage III or IV) cHL, patients should be given 2 cycles of ABVD followed by RT. Some patients may require another 2 to 4 cycles of ABVD and RT. Others may require 2 cycles of ABVD or BEACOPP followed by another PET scan. If there is still evidence of cancer, patients may require another 2 cycles of ABVD or BEACOPP with or without RT. Brentuximab vedotin (BV; Adcetris) with AVD (ABVD without bleomycin) may be offered to patients following ABVD treatment.

Patients that are over 60 are often given different treatment options because they are more likely to develop serious side effects. Older patients with early cHL with no risk factors should be offered ABVD or AVD followed by RT. Older patients with early cHL with risk factors or advanced cHL should be offered ABVD, BV with AVD, or other chemotherapy combinations such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone).  Participation in clinical trials should also be considered.

Some patients do not respond to treatment (refractory) and cHL returns after treatment in other patients (relapsed). For patients with refractory cHL, stem cell transplants (SCT), high-dose CT, BV, or RT are options. Patients with relapsed cHL should be offered SCT followed by RT. 

The authors concluded that treatment options differ depending on the stage of HL, risk factors, and age.