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  • Review Article
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State of the art in the treatment of Hodgkin lymphoma

Abstract

Hodgkin lymphoma (HL) has become one of the most easily curable malignancies in oncology. More than 80% of patients can be cured with risk-adapted treatment that includes chemotherapy and radiotherapy. This progress is mainly due to the development of multi-agent chemotherapy and improved radiation techniques; however, severe, life-threatening treatment-related side effects occur, which include organ toxicity and secondary malignancies. Thus, the treatment approaches must be carefully balanced between optimal disease control and the risk of long-term sequelae. Although this article is meant to provide an overview of the current treatment approaches for patients with HL, in many instances conflicting results from various clinical trials are available, and a personal judgment is inevitable. Here, we focus on evidence from large clinical trials with solid conclusions.

Key Points

  • Based on a large randomized phase III trial, two cycles of ABVD followed by 20 Gy involved-field radiotherapy is recommended as standard of care for early stage favourable Hodgkin lymphoma (HL)

  • Six cycles of escalated BEACOPP followed by 30 Gy radiotherapy for PET-positive residual lymphoma ≥2.5 cm is recommended as standard of care for advanced HL

  • Treatment with 6–8 cycles of ABVD followed by 30 Gy radiotherapy might be an alternative for patients with residual disease >1.5 cm or initial bulky disease

  • Treatment with two cycles of induction chemotherapy followed by high-dose chemotherapy with autologous stem-cell support is recommended for transplant-eligible patients in first relapse

  • In second or higher relapse, individual and palliative treatment is recommended; brentuximab vedotin has shown the most promising activity in this situation

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Figure 1: Design of the RAPID trial18 for patients with newly diagnosed early stage favourable HL.
Figure 2: Treatment algorithm for the treatment of early-stage HL.
Figure 3: Study designs of the GHSG HD17 trial,21 and the EORTC H10U trial16 for patients with newly diagnosed early stage unfavourable HL.
Figure 4: Study designs of the GITIL HD0607 trial40 and the GHSG HD18 (NCT00515554)41 trial for patients with newly diagnosed advanced-stage HL.

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Borchmann, P., Eichenauer, D. & Engert, A. State of the art in the treatment of Hodgkin lymphoma. Nat Rev Clin Oncol 9, 450–459 (2012). https://doi.org/10.1038/nrclinonc.2012.91

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