Early-Stage Hodgkin Lymphoma: A Case-Based Review of the Recent Literature

Abstract

The treatment of early-stage Hodgkin lymphoma remains controversial with combined modality therapy and chemotherapy alone representing acceptable options. Observation studies show a progressive decline in the use of radiation secondary to late complications but also suggest a decrease in survival for non-irradiated patients. Early PET CT scans have been incorporated into strategies of response-adapted therapy but have been imperfect in identifying patients who may require more aggressive treatment. In the absence of radiation, further improvement in the cure rate is likely to require better chemotherapy such as the incorporation of two cycles of dose-escalated BEACOPP or possibly the substitution of brentuximab for bleomycin. The treatment of patients who have relapse after abbreviated chemotherapy alone is not standardized and it remains unclear whether these patients should all receive highdose chemotherapy and autologous stem cell rescue or whether a significant fraction can be salvaged with conventional chemotherapy and radiation. Great care is required to ensure that patients considered for abbreviated treatment fulfil the eligibility requirements for inclusion as there are significant differences in the distinction between favorable and unfavorable in the most influential cooperative group studies.