Update regarding the treatment options for patients with Hodgkin lymphoma

This article reviewed the current treatment options for patients with Hodgkin lymphoma (HL).

Treatment options for patients with HL depend on the type of HL, stage of the disease, and the presence of risk factors. The stage of HL represents how widespread or severe the cancer is. Risk factors indicate that there is a high chance of cancer returning in patients. High-risk factors include being over 50, having cancer present in multiple lymph nodes, and having tumors in the chest cavity.  PET scans can now be used to adjust treatments.

Additionally, some patients do not respond to initial treatment (refractory), while HL returns in other patients after treatment (relapse). Patients with relapsed or refractory HL require different treatment options. A clear and recent indication of the most effective treatments for patients based on stage and risk factors is useful.

Patients who have stage I or IIA HL with low-risk factors should be given chemotherapy with radiotherapy (RT). Two cycles of the chemotherapy combination ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) followed by low-dose RT is often used.

Patients who have stage I or IIA HL with high-risk factors should also be offered chemotherapy with RT. Four cycles of ABVD followed by high-dose RT is most commonly used. Studies are ongoing to determine if biological drugs such as brentuximab vedotin (Adcetris) and nivolumab (Opdivo) improve treatment results.

PET scans are often used to examine how well patients are responding to treatment. If patients are not responding enough, they may be switched to another chemotherapy combination such as BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). If patients are responding well to chemotherapy, there may not be a need to complete RT.

ABVD chemotherapy is the most commonly used treatment for patients with advanced (stage IIB, III, or IV) HL. Patients who also have multiple high-risk factors may be offered BEACOPP chemotherapy instead. Recent studies have shown that brentuximab vedotin added to AVD chemotherapy significantly improves treatment results for patients. Studies examining the effectiveness of nivolumab plus AVD (ABVD without bleomycin) also look promising.

The majority of patients with HL have a type called classical HL. Nodular lymphocyte-predominant HL (NLPHL) is another type of HL that requires different treatment options. Patients with stage I NLPHL may be offered surgery instead of chemotherapy. Patients with advanced NLPHL may be offered ABVD with rituximab (Rituxan).

For patients with relapsed or refractory HL, high-dose chemotherapy followed by stem cell transplant (SCT) is the standard treatment. SCT is less effective for older patients. Recent trials showed that brentuximab vedotin improved treatment results after SCT.

If SCT is not effective for patients, chemotherapy drugs vinorelbine (Navelbine) or gemcitabine (Gemzar) are commonly offered. If feasible, participation in clinical trials should be offered to patients. Recent studies indicate that brentuximab vedotin or nivolumab may be more effective and safer options for patients. CAR T-cell therapy is another promising biological treatment still under investigation.

This study reviewed treatment options for patients with HL depending on the stage and risk factors.