Treating newly diagnosed Hodgkin lymphoma

This overview discusses initial treatment options for classical Hodgkin lymphoma (cHL). 

Classical HL is a cancer of the lymph nodes. Early-stage (stage I/II) cHL is contained to half the body, while advanced (stage III/IV) has spread to both the upper and lower halves of the body. Both early and advanced cHL have good outcomes when treated with chemotherapy and/or radiation. More recently treatments have avoided radiation because it can have late side effects such as a second cancer or lung disease. When a tumor is as wide as a third of the chest, this is known as bulky disease. Early-stage bulky cHL is often treated like advanced cHL.

This summary gives an overview of the treatment of newly diagnosed cHL.

The most common chemotherapy regimen is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). For patients with early-stage non-bulky cHL, 90.8% did not have the cancer return after ABVD. For patients with early-stage bulky cHL, those treated with ABVD alone were similarly likely to not have the cancer return as those treated with both ABVD with radiation (93% vs 97%). Doctors will typically use a PET-scan to test for cancer after the initial treatment. For patients whose scans still show cHL, radiation therapy will be used with another round of ABVD. Even for patients with advanced cHL, 70% can be cured with ABVD.

There is ongoing research on the treatment of patients with advanced disease whose PET scans show active cHL. Radiation treatment may not be suitable for these patients, because the cancer is throughout the body. The traditional option is extended BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Extended BEACOPP is an aggressive treatment, and has more severe side effects. Brentuximab vedotin (BV; Adcetris) is a targeted therapy which is another option. Using BV with AVD (similar to ABVD, but without bleomycin) led to significantly improved outcomes for patients with newly diagnosed advanced cHL (82.1% vs. 77.2%).

This summary found that ABVD chemotherapy is an effective treatment for most newly diagnosed cHL. For those whose scans show incomplete treatment, radiation and targeted therapy may be options.

BV is typically used as a treatment for cHL which has relapsed (returned) after previous treatment. Using BV during initial treatment makes it no longer a treatment option if cancer relapses.