Hodgkin Lymphoma: Recent Progress in Overall Management

Abstract

The overall approach to the management of Hodgkin lymphoma has undergone a rapid revolution. The Ann Arbor staging, proposed more than half a century ago, is still valid to guide treatment intensity, but all the invasive methods originally proposed have been replaced by a single high-performing tool of functional imaging: the Positron Emission Tomography coupled with Computed-Tomography (PET/CT). Apart from improving the overall accuracy of the Ann Arbor staging, new PET-derived metrics to measure the tumor burden such as metabolic tumor volume, total lesion glycolysis and tumor spread such as the Tumor Distance (Dmax), are ready to take over the classical four-level lymphoma staging. PET/CT has also downsized the role of radiation in the classic “combined modality treatment” for HL. PET/CT performed early during treatment (interim PET) for advanced-stage HL remains the standard of care in Europe to escalate treatment in patients starting with ABVD or to de-escalate treatment for patients starting with BEACOPP escalated. Finally, the therapeutic offer for patients failing first-line chemotherapy has been completely renewed by the advent of new non-chemotherapy agents such as Brentuximab Vedotin and Immune Checkpoint Inhibitors (CPI) which are now the standard of care along with autologous stem cell transplant (ASCT).