Hodgkin Lymphoma Treatment: Chemo, Radiation, Transplant, and Novel Therapies
Hodgkin lymphoma (HL) is a highly curable B-cell malignancy. Treatment is risk-adapted based on stage, prognostic factors (IPS), and patient factors.
Standard Frontline Regimens
| Stage / Risk | Preferred Regimen | Key Details |
|---|
| Early favorable (IA–IIA, no risk factors) | ABVD × 2–4 cycles ± ISRT (20–30 Gy) | De-escalation trials (RAPID, H10) omit radiation if PET-negative. |
| Early unfavorable (IA–IIA + risk factors) | ABVD × 4–6 cycles + ISRT (30 Gy) | Risk factors: bulky disease, >3 nodes, ESR>50, age>50. |
| Advanced (III–IV) | ABVD × 6 cycles or escalated BEACOPP × 4–6 + ISRT to bulky sites | BEACOPP higher CR but more toxicity (infertility, AML); age<60. |
Key Modalities
- Chemotherapy: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) – backbone. Bleomycin lung toxicity (avoid >60, pulmonary dysfunction).
- Radiation (ISRT): Involved-site RT; modern techniques (IMRT, proton) spare heart, breast, lung.
- Autologous Stem Cell Transplant (ASCT): Standard for relapsed/refractory HL. High-dose BEAM → autologous rescue. 5-yr PFS ~50–60%.
- Allogeneic Transplant: For post-ASCT relapse; graft-versus-lymphoma effect.
Novel / Targeted Therapies (Relapsed/Refractory)
- Brentuximab vedotin (BV): Anti-CD30 ADC – single agent or + bendamustine, AVD.
- PD-1 inhibitors (pembrolizumab, nivolumab): High RR in r/r HL; + BV synergistic.
- CAR T-cell therapy: Emerging for multiply relapsed.
Survivorship
- Late effects: secondary cancers (breast, lung, thyroid), cardiovascular disease, hypothyroidism, infertility, fatigue.
- Risk-adapted follow-up: echocardiogram, breast MRI (if chest RT), thyroid function, lipid profile, vaccination.
>80% long-term cure for advanced stage; >90% for early stage. Multidisciplinary care essential.
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