Hodgkin Lymphoma: Differences in Treatment Between Europe and the United States/North America: Evolving Trends in Protocol Therapy

Abstract

With continued progress and success in clinical care, the management of patients with Hodgkin lymphoma (HL) has undergone continuous revision to improve patient care outcomes and limit acute and late treatment effects on normal tissue imposed by therapy. Hodgkin lymphoma is a disease that affects children, adolescents, and adults. Clinical management strategies are influenced by the patient’s age at diagnosis, tumor burden, response to induction therapy, and potential expectation of treatment impact on normal tissue. The approach to patient management varies in many parts of the world and is influenced by treatment availability, physician training, and medical culture. Differences in approach are important to understand for accurately comparing and contrasting outcome studies. In this article, we will identify current areas of common ground and points of separation in patient care management for HL. Opportunities for clinical trial strategies will be defined for future clinical trials.

Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

“…Unfortunately, there is no published data regarding adolescents treated with adult protocols in Italy, but recent studies conducted elsewhere in Europe showed no significant differences between the two approaches, even if a widespread use of RT and anthracyclines is generally observed in adult trials [ 24 , 44 ]. Data from the Canadian IMPACT (Initiative to Maximize Progress in Adolescent and Young Adult Cancer) study, comparing the outcome of 15–21 year-old AYAs treated in pediatric or adult centers between 1992 and 2012, showed no differences in OS and EFS.…”

Risk-Adapted, Combined-Modality Therapy for Unfavorable Pediatric Hodgkin Lymphom

“…There and we will need to be careful in reviewing publications, understanding that there may be differences in clinical trial populations within specific groups [17].…”

“…Protocols in advanced-stage patients evaluate the role of RT directed to areas at the presentation that do not fully respond to chemotherapy and/or sites of bulk disease at presentation (mediastinum) in COG trials [17].…”

Effective treatment of advanced Hodgkin lymphoma with a modified BEACOPP regimen for a patient with demyelinating hereditary motor and sensory neuropathy type 1 (HMSN1)

“…The therapeutic strategy for Hodgkin lymphoma is designed according to the Ann‐Arbor staging classification, additional risk factors and the age of the patient. 1 Depending on the country, two main regimens for Hodgkin lymphoma (HL) build the standard (individually or in combination), ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Advantages of the ABVD regimen are the lower toxicities and overall costs.…”