What are NCCN treatment guidelines for early-stage, low risk Hodgkin lymphoma (Hodgkin disease)?

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

Current National Comprehensive Cancer Network (NCCN) guidelines give two cycles of the ABVD regimen a category 1 rating (ie, the recommendation is based on high-level evidence and uniform NCCN consensus that the intervention is appropriate), but list the Stanford V regimen as an alternative. [4] Direct comparisons of ABVD with the Stanford V regimen in early-stage favorable disease have not been reported to date.

The number of chemotherapy cycles and doses of radiation vary based on patient population. The German Hodgkin Study Group (GHSG) HD10 trial evaluated patients with early-stage favorable disease (defined as no more than two sites of disease, no extranodal extension, no bulky mediastinal disease, and ESR < 50 [or < 30 with B symptoms]) by looking at the following four different combinations [40] :

  • ABVD x four cycles, followed by IFRT 30 Gy
  • ABVD x four cycles, followed by IFRT 20 Gy
  • ABVD x two cycles, followed by IFRT 30 Gy
  • ABVD x two cycles, followed by IFRT 20 Gy

This study showed no difference in overall survival, freedom from treatment failure, and progression-free survival among the groups, but it did show significantly less toxicity in the lower chemotherapy and radiation arm. [40] The results suggested that ABVD for two cycles followed by IFRT 20 Gy is an acceptable treatment for patients with early-stage disease.


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