Management of Hodgkin Lymphoma

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The current standard of care for patients with Hodgkin lymphoma is based on a clinical staging system that individualizes treatment based on the stage of disease. For patients with early stage Hodgkin lymphoma, prognostic factors are used to separate those with favorable disease from those with unfavorable disease, Anas Younes, MD, notes. Individuals with limited stage Hodgkin lymphoma typically receive the standard chemotherapy regimen of doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) in combination with involved-field radiation, explains John Sweetenham, MD.

The amount of chemotherapy and radiation that is delivered depends on a series of prognostic factors beyond simply knowing whether the patients have low-risk or high-risk disease. Sweetenham notes that certain groups of individuals with favorable disease can show positive responses after 4 cycles of chemotherapy and no radiation, adding that many centers now avoid radiation therapy, if possible, in patients with favorable risk, early stage disease.

However, individuals with bulky disease (defined by a mediastinal mass greater than 10 cm in diameter) have a relatively poor outcome. The primary treatment approach for these patients generally involves 4 cycles of chemotherapy and consolidated involved-field radiation. Other approaches have looked at intense chemotherapy and dosing differences in radiation. For the most part, a management strategy for bulky Hodgkin lymphoma remains unstandardized, says Sweetenham.

Older patients with Hodgkin lymphoma have an increased risk of toxicity and may not tolerate ABVD as well as their younger counterparts, observes Sweetenham. The standard approach with these patients is to administer ABVD and monitor closely for the emergence of lung toxicity associated with bleomycin. Sweetenham states there is an increasing trend toward using newer agents, such as brentuximab vedotin, in older patients to reduce their risk of toxicities experienced with standard therapies.