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Early-stage classical Hodgkin lymphoma

Paul J. Bröckelmann, Stephanie Sasse and Andreas Engert

Abstract

With defined chemo- and radiotherapy and risk-adapted treatment, early-stage classical Hodgkin lymphoma (HL) has become curable in the majority of patients. A major current goal is hence to reduce treatment-related toxicity while maintaining long-term disease control. Patients with early-stage favorable disease, i.e. limited stage without risk factors (RFs), are frequently treated with two cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (2xABVD) followed by 20Gy involved-field or -site radiotherapy (IF/IS-RT). In patients with early-stage unfavorable disease, i.e. limited stage with RFs, four cycles of chemotherapy are usually consolidated with 30Gy IF/IS-RT. Compared to 4xABVD, two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (2xBEACOPPescalated) followed by 2xABVD ("2+2") improved 5-year progression-free (PFS) with similar 5-year overall survival (OS). Recently treatment strategies based on 18FFDG positron emission tomography (PET) response were evaluated. In early-stage unfavorable HL, the majority of patients achieved a negative interim-PET after 2xABVDand an excellent outcome after 4xABVD, while in those with a positive interim-PET, 2xBEACOPPescalated improved 5-year PFS. Further, a PET-guided RT-approach was evaluated to decrease long-term toxicity. While both, the RAPID and H10 trial, reported poorer disease control without RT, PET-guided omission of RT can constitute a valid therapeutic option in patients with an increased risk of RT-associated toxicity e.g. due to sex, age or disease localization. Implementation of drugs such as the anti-CD30 antibody-drug-conjugate brentuximab vedotin (BV) or the anti-PD1 antibodies nivolumab or pembrolizumab might allow further reduction of overall mortality and improve the quality of life in affected patients.

  • Submitted October 3, 2017.
  • Accepted February 7, 2018.