hematology and oncology
Hodgkin Lymphoma
Treatment of Hodgkin Lymphoma
Chemotherapy Antibody-drug conjugate (eg,brentuximab vedotin) Immunotherapy (eg, immune checkpoint inhibitors) Radiation therapy Sometimes autologous stem cell transplantation The choice of treatment modality is complex and depends on the precise stage of disease. Before treatment and when applicable, men should be offered sperm banking, and women should discuss options to preserve fertility with their oncologists and a fertility specialist. (ABVD) with or without Radiation Therapy for Cancer . In patients with bulky mediastinal disease, chemotherapy may be of longer duration or of a different type, and radiation therapy is often included. [ Treatment references ]). In the ECHELON-1 trial, patients treated with AVD plus the anti-CD30 antibody-drug conjugate Multiple second-line chemotherapy regimens are considered acceptable for patients who are not cured with first-line therapy. For patients who achieve a good response to second-line therapy, high-dose chemotherapy and Hematopoietic Stem Cell Transplantation should be considered, while non-responders may be candidates for subsequent lines of therapy or allogeneic stem cell transplantation. Brentuximab vedotinand the checkpoint inhibitorsnivolumabandpembrolizumabcan be used for treatment of patients with Hodgkin lymphoma who have received at least 2 prior forms of therapy but are increasingly being used in second-line regimens. as well as mediastinal radiation increases the risk of Overview of Cardiomyopathies , All patients who are not PET-negative at the end of induction therapy should have a biopsy or be followed closely with serial imaging; if residual disease is present, additional treatment is necessary. Once in remission, patients should be followed for signs and symptoms of relapse for 5 years. Those with manifestations of relapse, defined as reappearance of disease at sites of prior disease or at new sites, should have imaging with PET/CT or CT alone. Routine, scheduled imaging in asymptomatic patients is not mandatory. For a schedule of posttreatment surveillance, see table Hodgkin Lymphoma Posttreatment Surveillance . 1.Johnson P, Federico M, Kirkwood A, et al: Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's lymphoma.N Engl J Med374(25):2419– 2429, 2016. 2.Connors JM, Jurczak W, Straus DJ, et al:Brentuximab vedotinwith chemotherapy for stage III or IV Hodgkin's lymphoma.N Engl J Med378(4):331–344, 2018. Epub 2017 Dec 10. 3.Straus DJ, Długosz-Danecka M, Connors JM, et al:Brentuximab vedotinwith chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial.Lancet Haematol8(6):e410–e421, 2021. doi: 10.1016/S2352-3026(21)00102-2 