Treatment of advanced-stage hodgkin lymphoma

Abstract

Before the introduction of combination chemotherapy, more than 95% of patients with advanced classical Hodgkin lymphoma (cHL) succumbed to their disease within 5 years. Thus, remission rates in excess of 50% achieved with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) were a major breakthrough in oncology when first seen over 40 years ago. Systematic searches for more effective regimens have replaced MOPP by ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). With today’s high survival rates exceeding 90%, it is important to balance cure against short- and long-term adverse effects of treatment. Consequently, response-adapted approaches, mainly using 18-fluorodeoxyglucose-positron emission tomography-computer tomography (FDG-PET-CT), have been introduced as the standard of care allowing for individualized tailored treatment. After many years without new drugs, research has been energized by the possible introduction of novel agents, that is, the antibody-drug conjugate brentuximab vedotin and programmed death receptor-1 inhibitory antibodies, which are increasingly being tested as components of initial therapy.