Treatment

Early stage (I and II): combination of chemotherapy and radiation therapy

• The most widely used chemotherapy approach is ABVD: adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine

Advanced stage (III and IV and often II with bulky disease): combination chemotherapy with radiation therapy in select cases

• Three possible treatment approaches are commonly considered:

  • ABVD

  • Stanford V: doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone

  • BEACOPP: bleomycin, etoposide, adriamycin (doxorubicin), cyclophosphamide, oncovin (vincristine), procarbazine, prednisone

Primary refractory or relapsed disease: trial of alternative chemotherapy or consideration of high-dose chemotherapy and autologous stem cell transplantation

Good prognosis

• 5-year survival rate ∼ 80–90% (in children > 90%)

• Best prognosis: lymphocyte-rich classical HL and (LRHL) and nodular lymphocyte predominant HL (NLPHL)

Prognosis is largely determined by disease stage (i.e., lower stage has a better prognosis)

∼ 10–20% of patients will develop secondary malignancies (especially lung cancer; related to radiation therapy and chemotherapy)

Unfavorable factors for Hodgkin lymphoma (relevant when selecting a treatment regimen)

• High ESR

• High LDH

• Involvement of three or more lymph node areas

• Large mediastinal tumor

• Bulky disease (tumors measuring ≥ 10 cm across)