Haema 2012; 3(3): 212-230
by Theodoros P. Vassilakopoulos, Georgios Boutsikas, Andreas Sarris, Maria K. Angelopoulou
Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Goudi, Athens, Greece
Abstract
Hodgkin lymphoma (HL) is a highly curable malignancy of B-cell origin. Patients are classified into early, intermediate and advanced stages based on the Ann Arbor staging system and the presence of certain risk factors (mediastinal bulk, B-symptoms and ESR, number of involved nodal sites and localized extranodal extension or age). Early stage patients (stages I/II without risk factors) are treated with 2-4 cycles of ABVD plus 20-30 Gy involved field radiotherapy (IF-RT). Intermediate stages (stages I/II with ≥1 risk factors) require 4-6 cycles of ABVD plus 30 Gy IF-RT, while more intensive chemotherapy improves tumor control without any overall survival benefit. In advanced stag- es (III/IV and probably IIB with mediastinal bulk and/or extranodal extension), BEACOPP-escalated is superior to ABVD-equivalents in patients up to 60 years old, but potential benefits in terms of overall survival are achieved at the expense of increased acute toxicity, toxic deaths and risk of secondary leukemias. Recent data suggest that limiting BEACOPP-escalated to 6 cycles instead of 8 may be associat- ed with much lower rates of toxic deaths and leukemogenicity. Early response assessment with interim PET may permit to limit treatment intensification with BEACOPP-escalated in a relatively small minor- ity of advanced stage patients, who really need it. Post-chemotherapy PET-based evaluation of response has already limited the need of RT in advanced stages; this is especially true after BEACOPP-escalated, since the use of RT can be restricted to ~10% of patients. It is hoped that the optimal use of PET will al- so eliminate the need of RT in the majority of early stage patients in the near future. In addition to the prognostic classification of limited stages reported above, the IPS remains the basis for the prediction of outcome in advanced stages. Numerous novel biological prognostic factors have been described, but have not been adopted in everyday practice because of issues of reproducibility and lack of prospective validation. However, progress in understanding the biology of HL may lead to better risk classification and provide a guide to individually tailored treatment in the forthcoming years.