Hodgkin lymphoma: EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up

Abstract

Hodgkin lymphoma (HL) is a B-cell-derived malignancy often affecting young adults. Allocation into risk groups is based on staging with positron emission tomography and computed tomography (PET/CT) and the presence or absence of risk factors. Standard treatment for early-stage favorable classic HL (cHL) consists of two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), followed by 20 Gy involved-site radiotherapy (IS-RT). Two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) or a procarbazine-free eBEACOPP variant plus two cycles of ABVD, followed by 30 Gy IS-RT in the case of PET/CT positivity and no further treatment in the case of PET/CT negativity after chemotherapy should be considered in patients with early-stage unfavorable cHL ≤ 60 years. If a less intensive approach is preferred and in individuals > 60 years, four cycles of A(B)VD followed by 30 Gy IS-RT can be given. In advanced cHL, brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD) for four (in the case of PET/CT negativity after two cycles) or six cycles (in the case of PET/CT positivity after two cycles), followed by PET/CT-guided 30 Gy IS-RT should be considered in patients ≤ 60 years. Six cycles of nivolumab and AVD (N-AVD) followed by PET/CT-guided 30 Gy IS-RT represents a less intensive alternative for younger patients and the preferred approach for patients > 60 years. Patients with cHL recurrence should receive checkpoint inhibitor-containing salvage treatment followed by high-dose chemotherapy and autologous stem cell transplantation if eligible. Treatment of nodular lymphocyte-predominant HL differs from cHL in some situations and may contain an anti-CD20 antibody. This guideline aims at providing recommendations for diagnosis, staging, treatment, and follow-up of HL.