Therapeutic recommendations for early stage Hodgkin lymphomas

Abstract

Summary Combined modality treatment has been the standard option for the treatment of early stage Hodgkin lymphoma for several decades. Because of the high success rate and the risk of late toxicities, recent clinical trials have focused on reducing the treatment burden. Field and dose of radiotherapy, and number of cycles of chemotherapy have been successfully reduced, particularly for favourable early stage patients. However, the impact of these treatment reductions on the rate of secondary malignancies remains still unclear. Positron emission tomography‐computed tomography (PET‐CT) scanning has emerged as a very important tool for disease staging and end of treatment assessment. Interestingly, a PET performed after 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) has been correlated with final outcome and was recently evaluated in a randomized clinical trial to evaluate individualized therapy based on PET response after 2 or 3 cycles of ABVD. These trials aimed to identify good prognosis (early PET‐negative) patients who could be spared radiotherapy, but also patients with a bad prognosis (early PET‐positive) who need more intensive treatment. More recently, new drugs, such as brentuximab vedotin and checkpoint inhibitors, have shown efficacy in relapsed/refractory patients and are currently under evaluation in early stage patients.

Continuum of Care for Hodgkin Lymphoma: Impact of Modern Therapy on Postacute Morbidity and Mortality

“…Classic Hodgkin lymphoma (cHL) is a highly curable cancer. [1][2][3][4] However, due in part to the young age of most patients, treatment-related toxicities and late effects, such as secondary malignant neoplasms (SMNs) and cardiovascular disease (CVD), can adversely affect survival. Cost-per-death analyses have shown that HL has the second highest cost per death or lost-productivity cost (behind only malignant melanoma), 5 and productivity analyses of cancer mortality have shown HL to be the second most costly cancer in terms of lost lifetime earnings.…”