What treatment regimens are used for early-stage, unfavorable 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

The preferred regimen is ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, dacarbazine), although other regimens are acceptable, including Stanford V and dose-escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). It should be noted that these regimens are chosen not because they have been proven to be superior in managing early-stage disease; rather, they are an extrapolation from treatment of advanced disease, in which ABVD has been shown to have superior outcomes. [71]

At least two trials have compared therapy with escalated-BEACOPP versus ABVD in early-stage, unfavorable Hodgkin lymphoma. [59] These trials have shown that there does not appear to be a benefit to the use of dose-escalated BEACOPP relative to four cycles of ABVD. In addition, the toxicity was greater with BEACOPP therapy. [59] The results of these studies suggest that ABVD for four cycles followed by 30 Gy of IFRT is the current standard of care.

Similarly, in another study that examined alternating dose-escalated BEACOPP with ABVD versus ABVD alone with both regimens followed by IFRT, the escalated-BEACOPP regimen failed not only to show a survival advantage to the dose-intense regimen but also showed increased toxicity. [72]

It is a matter of debate as to whether chemotherapy alone can be used in patients with unfavorable disease. As noted, the only trial completed to date, the HD6 trial, did include patients with unfavorable Hodgkin lymphoma. [68] Given the flaws in design, particularly the use of outdated radiation therapy, the conclusions are limited. Regardless, chemotherapy alone may be an option for early-stage unfavorable patients without bulky disease.


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