In a nutshell
This study reviewed recommendations for the staging and treatment of Hodgkin lymphoma.
Some background
Current treatment options for Hodgkin lymphoma have led to a cure rate of 80%. Radiation with or without chemotherapy has become the standard treatment. These treatments, however, can lead to long-term negative effects, such as second cancers and cardiovascular disease. An understanding of the risks and benefits of different therapies can help to guide individual treatment choice.
The SEOM is a panel of experts based in Spain. This panel reviewed current research on treatment options. They have outlined their recommendations for the staging and treatment of Hodgkin lymphoma.
Methods & findings
The current study reviewed the recommendations of the SEOM.
Treatment choices depend on the stage of the disease. Hodgkin lymphoma is staged based on multiple factors. These include the number and location of involved lymph nodes, the size of the tumors, and whether there are other symptoms. These symptoms include weight loss, night sweats, and fever.
Treatment for patients with early-stage disease (stage I or II) is based on whether the cancer is favorable or unfavorable. Patients with unfavorable disease have certain risk factors. These include more than two involved groups of lymph nodes, larger tumors in the chest, and signs of inflammation based on blood tests. The treatment recommendation for unfavorable disease is 4 cycles of the chemotherapy ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) followed by radiation. Recommended treatment for favorable early-stage disease is 2 cycles of ABVD followed by a lower dose of radiation.
Advanced disease refers generally to stages III or IV. The SEOM recommended treatment is 6 to 8 cycles of ABVD. For patients who show a complete remission (no sign of cancer) after 2 or 3 cycles, 6 cycles may be enough. Other chemotherapy combinations, such as BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), have been examined. This treatment led to longer periods without disease progression. There was no improvement in overall survival (time from treatment until death from any cause).
10% to 15% of early-stage and 20% to 40% of advanced-stage patients may experience a relapse or they may not respond to treatment. The first recommended treatment for these patients is salvage chemotherapy (a course of a different combination). This should be followed by high dose chemotherapy and a stem cell transplant. Brentuximab vedotin (Adcetris) is recommended for patients who relapse after a stem cell transplant. This is an antibody that binds to cancer cells, allowing a chemotherapy to enter the cell and destroy it. One study reported a 75% response rate to this therapy.
Following treatment patients should be followed every 4 to 6 months for the first 5 years. Blood and imaging tests depend on the individual patient needs.
The bottom line
This study reviewed the guidelines and recommendations set by the SEOM for the treatment of Hodgkin lymphoma.
Published By :
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
Date :
Dec 01, 2015
