Treatment of NLPHL

Abstract

The modern treatment of Hodgkin lymphoma is associated with two major types of risk: the risk that the treatment will fail to cure the disease and the risk that the treatment will prove unacceptably toxic. Careful assessment of the amount of the lymphoma (tumor burden), its behavior (the extent to which is has invaded or compromised specific organ function) and special host-related factors (age, coincident systemic infection and organ dysfunction, especially of the hematopoietic system, heart and lungs) is essential to optimize treatment outcome. Elaborately assembled prognostic factor scoring systems, such as the International Prognostic Factors Project score, have lost much of their accuracy and value as increasingly effective chemotherapy and supportive care have been developed. A new era in which specific biomarkers derived from sophisticated exploration of Hodgkin lymphoma biology are being identified and validated brings promise of further improvement in targeted therapy in which effectiveness is increased at the same time that off-target toxicity is diminished. Parallel developments in the application of functional imaging are bringing additional potential to evaluate the efficacy of treatment even as it is being delivered allowing dynamic assessment of risk in the midst of chemotherapy and adaptation of the treatment regimen in real time. Risk assessment in Hodgkin lymphoma is continuously evolving and promises even greater precision and specific clinical relevance in the future. In this article we will explore the past usefulness and emerging potential of risk assessment for this imminently curable malignancy.