Treatment of Hodgkin's disease

Majority of localised and advanced Hodgkin’s lymphoma can be treated successfully. Unlike many other forms of cancer, even if first-line treatment fails the condition is often possible to cure but the dilemma is whether it is better to use a more extensive treatment (to cure as many individuals as possible) or less intensive treatment (followed by aggressive salvage therapy) initially (1).

British Committee for Standards in Haematology recommends the following as first line management of HL

• favourable early stage disease
  • with the current available data, the standard of care for treatment of patients with early stage favourable HL includes combination modality therapy using adriamycin, bleomycin, vinblastine, and decarbazine (ABVD) for 2 cycles and 20 Gy radiotherapy
• unfavourable early stage disease
  • currently four cycles of ABVD followed by 30 Gy RT is widely considered the standard of care for unfavourable early stage HL
  • another treatment option for unfavourable early stage HL is 2 cycles of bleomycin/etoposide/adriamycin/cyclophosphamide/vincristine/procarb (BEACOPP) escalated doses + 2 x ABVD and 30Gy RT
• advanced stage disease
  • patients aged 16 to 60 with advanced stage HL should receive either 6-8 cycles of ABVD or 6 cycles of escalated BEACOPP
  • the European Society for Medical Oncology (ESMO) recommend localised radiation with 30 Gy to residual lymphoma greater than 1.5cm

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) can be regarded as the treatment of choice for patients who have relapsed following treatment with chemotherapy (2).

Reference:

• (1) Yung L, Linch D. Hodgkin's lymphoma. Lancet. 2003;361(9361):943-51
• (2) Eichenauer DA, Engert A, Dreyling M; ESMO Guidelines Working Group. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2011;22 Suppl 6:vi55-8