This document discusses treatment options for Hodgkin lymphoma based on stage. For early stage (I-II) favorable prognosis, ABVD chemotherapy for 3-4 cycles followed by radiation is most commonly used. For early stage unfavorable prognosis, ABVD plus radiation is standard. For advanced stage (III-IV) ABVD is standard but BEACOPP shows improved progression-free survival over ABVD though with greater toxicity. Radiation is often used along with chemotherapy depending on risk factors.

1. Treatment of Hodgkin
Lymphoma

2. Treatment of Hodgkin lymphoma
 Selection of initial treatment for
HL is usually based upon
presenting stage and prognostic
factors.
 An important issue during any
form of therapy is monitoring for
extent of disease.

4. Early stage HL (stage I-II)
 Divided into favorable and unfavorable prognosis .
 The two most commonly used definitions of
favorable disease are the European Organization
for the Research and Treatment of Cancer (EORTC)
and the German Hodgkin Study Group (GHSG).

5. Early stage HL (stage I-II)
 The EORTC defines favorable prognostic group as
patients age 50 or under , without large mediastinal
adenopathy , with an ESR of less than 50 , and no B
symptoms (or with an ESR of less than 30 in those who
have B symptoms), and disease limited to three or
fewer regions of involvement.
 The GHSG defines favorable prognostic group as
patients with no more than two sites of disease , no
extranodal extension, no mediastinal mass measuring
one-third the maximum thoracic diameter or greater;
and ESR less than 50 (less than 30 if B symptoms
present).

6. Favorable prognosis - Early stage HL
(stage I-II)
 ABVD(doxorubicin, bleomycin, vinblastine, dacarbazi
ne) for three - four cycles, followed by involved field
irradiation to 30 Gy with fields encompassing the
initially involved lymph node site , This approach has
the lowest relapse rate.
 ABVD for four to six cycles without radiation therapy.
This is an emerging option for patients at risk of long-
term complications from radiotherapy. Disease control
with combined therapy is superior compared with
chemotherapy alone , but this must be weighed
against the risks of radiotherapy.

7. Unfavorable prognosis - Early stage
HL (stage I-II)
 ABVD(doxorubicin, bleomycin, vinblastine,
and dacarbazine) remains the "gold standard"
chemotherapy for these patients .
 For most patients, ABVD plus radiation therapy.

8. Advanced stage HL (stage III-IV)
 ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)
has been the standard regimen .
 BEACOPP(bleomycin, etoposide, doxorubicin, cyclophosphamide
, vincristine, procarbazine, and prednisone) incorporate
radiation therapy for most patients and have shown advantages
in freedom from progression but not overall survival when
compared with ABVD in three randomized trials.
 advantages with this more intense regimen is a reasonable
alternative to ABVD for patients with the highest risk of relapse .
 BEACOPP is associated with higher rates of toxicity including
reversible bone marrow suppression, secondary malignancies,
sterility, and rare cases of fatal sepsis.
 Toxicities are particularly severe in the elderly, making it
inappropriate in this population.

9. Advanced stage HL (stage III-IV)
 StanfordV(doxorubicin, vinblastine, mechloretha
mine, vincristine, bleomycin, etoposide,
and prednisone) incorporates radiation therapy for
all patients and may be preferred in some settings
because of its short administration schedule and
decreased pulmonary toxicity.
 It may have advantages for certain patients,
particularly those for whom radiation will be part
of their planned therapy. Randomized trials have
demonstrated no advantage over ABVD.