Advanced-stage Hodgkin lymphoma

Background In recent years, positron emission tomography (PET)-adapted protocols and new agents such as brentuximab vedotin are increasingly used as part of first-line protocols of advanced-stage Hodgkin lymphoma (HL). Objectives This manuscript reviews guideline-based therapy and available trial data in advanced-stage HL. Materials and methods This is a narrative review. Results The German HL guideline recommends interim PET2-guided (PET after 2 cycles) chemotherapy using 4 cycles of eBEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) for PET2-negative patients up to 60 years of age with advanced HL and 6 cycles eBEACOPP for PET2-positive patients. Furthermore, patients with PET-positive residual lymphoma should receive consolidation radiotherapy with 30 Gy. This is based on effective tumor control and short duration of therapy of 3 months in most patients. For elderly patients, treatment with 2 cycles of ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) followed by 4 cycles of AVD and irradiation of PET-positive residuals is recommended. Conclusions Advanced-stage HL is curable in more than 90% of cases. The goal of current scientific efforts is to reduce toxicity while maintaining efficacy by including immune checkpoint inhibitors.