Treatment Guidelines for classical Hodgkin Lymphoma in adults

This article reviewed the NCCN guidelines for the treatment of classical Hodgkin lymphoma in adults 18 years of age or older. 

Hodgkin lymphoma (HL) is generally considered a curable disease. Most HL occurs in young people between 15 and 30 years old. The most common treatments are chemotherapy and radiation. These treatments, however, have been associated with long-term complications. Current research focuses on reducing treatment intensity in order to reduce later complications. 

This article outlined the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of classical HL in adults.

Before receiving treatment, all women should undergo a pregnancy test. Fertility preservation is recommended for both men and women. Preservation options include semen cryopreservation for men and oocyte or ovary tissue cryopreservation for women.

Stage I/II favorable: Treatment with chemotherapy followed by involved site radiation therapy (ISRT) is recommended. Chemotherapy alone is acceptable for younger patients. After 3 cycles of successful ABVD chemotherapy, there was little difference in 3-year overall survival (time from treatment to death from any cause) between patients who received (97%) and did not receive (99%) radiation therapy. Reducing treatment intensity reduces the likelihood of treatment-related diseases later in life. 

Stage I/II unfavourable: Treatment with chemotherapy followed by ISRT is recommended. This treatment is generally more intense than the treatment for favorable HL. Another treatment option is chemotherapy only: ABVD followed by AVD (same as ABVD, but without bleomycin). After 2 successful cycles of ABVD, patients were randomized to receive either ABVD or AVD chemotherapy. The 3-year overall survival between the two groups was similar (ABVD: 97.2% vs AVD: 97.6%). AVD chemotherapy is less toxic on the body, and leads to fewer pulmonary (lung) issues after treatment.

Stage III/IV: Increased intensity chemotherapy is recommended to treat stage III/IV HL. ABVD is the preferred treatment in patients with stage II/IV disease. Stanford V and escalated BEACOPP are also effective for some patients with stage II/IV HL. Radiation therapy is recommended if patients are not responding to chemotherapy.

Treatment-associated diseases in HL survivors are common because of the high treatment intensity. The most common late effects are secondary cancers, heart disease, hypothyroidism (an under-active thyroid), and fertility problems. These complications are generally due to local radiation treatment. They usually occur between 5 and 10 years after treatment completion. It is recommended to get checked regularly for these conditions after HL treatment is complete. 

This study reviewed the recent NCCN guidelines for the treatment of classical HL in adults. 

These treatment recomendations may not be the same for older adults. Treatment for older patients is often more individualized, and may be less intense, depending on the overally health, condition, and fitness of the patient. Some may not be able to tolerate intensive chemotherapy.