Adult Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version

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Changes to This Summary (11/22/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Cellular Classification of Adult Hodgkin Lymphoma (HL)

Added Eichenauer et al. as reference 8.

Stage Information for Adult HL

Revised text to state that clinical staging for patients with HL includes a history, physical examination, laboratory studies, and thoracic and abdominal/pelvic computerized tomographic (CT) scans with or without positron emission tomography (PET) (cited Barrington et al. as reference 2).

Revised text to state that PET scans combined with CT scans have become the standard imaging for clinical staging.

Treatment Option Overview for Adult HL

Revised text to state that at a 15-year follow-up, the risk of second solid tumors is approximately 13%; at a 20-year follow-up, the risk is approximately 17%; at a 25-year follow-up, the risk is approximately 22%; and at a 40-year follow-up, the risk is approximately 48% (cited Schaapveld et al. as reference 21).

Revised text to state that the risk appears greatest for women treated with radiation before age 30 years and especially close to menarche, and the incidence increases substantially after 15 years of follow-up (cited Cooke et al. as reference 34).

Added van Nimwegen et al. as reference 55.

Added text to state that patients older than 60 years with HL may experience more treatment-related morbidity and mortality; maintaining dose intensity of standard chemotherapy may be difficult. Alternative therapies have been proposed for elderly patients, but no randomized trials have been conducted with these regimens (cited Kolstad et al. as reference 67). A series of 27 previously untreated patients older than 60 years, judged by the investigator to be in too poor a condition to undergo chemotherapy, received brentuximab; a 92% overall response rate and 73% complete remission rate were reported (cited Forero-Torres et al. as reference 68 and level of evidence 3iiiDiv).

Advanced Favorable HL

Added Merli et al. as reference 11. Also revised text to state that with a median follow-up of 120 months, although progression-free survival (PFS) favored bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) over doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), there was no significant difference in overall survival (OS).

Advanced Unfavorable HL

Added text to state that transplant-related mortality with escalated BEACOPP increases in older patients, especially with poor performance status (cited Wongso et al. as reference 10).

Recurrent Adult HL

Revised text to state that for relapsing patients, response rates around 75% are seen with complete remissions around 30% to 50% and median PFS of 4 to 8 months. Added that a series of 27 previously untreated patients older than 60 years, judged by the investigator to be in too poor a condition to undergo chemotherapy, received brentuximab; a 92% overall response rate and 73% complete remission rate were reported (added level of evidence 3iiiDiv).

Revised text to state that patients who relapse after initial combination chemotherapy can undergo reinduction with the same or another chemotherapy regimen followed by high-dose chemotherapy and autologous bone marrow or peripheral stem cell or allogeneic bone marrow rescue.

Added text to state that a Cochrane meta-analysis also concluded that autologous stem cell transplantation after reinduction chemotherapy improves relapse-free survival by 20% to 30% over chemotherapy alone, but without an OS benefit (cited Rancea et al. as reference 28 and level of evidence 1iiDii).

HL During Pregnancy

Added text to state that there is no evidence that a pregnancy after completion of therapy increases the relapse rate for patients in remission (cited Weibull et al. as reference 18).

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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