What are goals of Hodgkin lymphoma (Hodgkin disease) treatment?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Given the curable nature of this disease and patients’ long-term survival, goals for treatment are the following:

  • Maximize cure for all stages

  • Minimize both short-term and long-term complications, assuming this does not have an impact on cure

  • Weigh the risks of toxicity (eg, elderly patients might not tolerate acute toxicities as well as younger patients, and given their prognosis from other conditions, aggressive treatment in seniors might not be indicated)

The overarching theme is assessing patients individually for their extent of disease, disease-related prognosis, associated conditions, risk of relapse, and long-term survival. By taking these factors into account, treatment can be tailored to each patient.

There are several examples of changes to treatment over the last several decades that illustrate these goals, such as the following:

  • Minimizing the number of cycles of chemotherapy used

  • Changing radiation fields to include only involved-field radiation

  • Enhancing surveillance for toxicity

  • Realizing that even relapsed disease can often be salvaged with stem cell transplantation, allowing for less intense treatments upfront

The above considerations apply mainly to classical Hodgkin lymphoma, but many of these principles can be applied to nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) as well. In general, NLPHL is clinically distinct from classical Hodgkin lymphoma in that NLPHL generally presents as early-stage disease that can be treated with local measures (surgery, radiation) or followed expectantly. However, some cases of NLPHL can transform to aggressive non-Hodgkin lymphomas that are treated using standard protocols. It is important to note the differences in immunophenotype; for example, NLPHL being CD20-positive allows for successful treatment with rituximab either alone or in combinations.

See also Hodgkin Lymphoma Treatment Protocols.


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