Management of unfavorable prognosis early stage classical Hodgkin lymphoma

ABVD: doxorubicin, bleomycin, vinblastine, and dacarbazine; PET: positron emission tomography; CT: computed tomography; CR: complete response; PR: partial response; PD: progressive disease; ESR: erythrocyte sedimentation rate; cHL: classical Hodgkin lymphoma; BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone.
* Large mediastinal adenopathy (at least 10 cm or one-third of the cardiothoracic diameter); ESR at least 50 mm/hour with no B symptoms, or ESR at least 30 mm/hour with B symptoms.
¶ For select patients with large mediastinal adenopathy in whom radiation therapy is felt to pose an excessive risk, treatment with six to eight cycles of ABVD is an option; further details are presented in UpToDate content on management of unfavorable prognosis early stage cHL.
Δ The most common initial chemotherapy option is ABVD; some experts suggest alternative regimens (refer to UpToDate content on the treatment of unfavorable prognosis early stage cHL).
◊ Perform PET/CT just before next scheduled chemotherapy cycle; CR (Deauville 1 to 3), PR (Deauville 4 to 5), PD (radiologic or clinical progression).
§ Some experts recommend changing to BEACOPP if PR after two cycles of ABVD; further details are presented in UpToDate content on management of unfavorable prognosis early stage cHL.
¥ Total of six cycles of ABVD is preferred for patients with unfavorable prognosis cHL.
‡ If PR after ABVD cycle 4, a decision to proceed with two additional cycles of ABVD versus salvage systemic chemotherapy depends on the clinician's judgment regarding chemotherapy responsiveness of cHL.
† Further details are presented in UpToDate content on the treatment of relapsed or refractory cHL.
** Routine PET/CT surveillance is not recommended after achievement of CR; further details are presented in UpToDate content on monitoring the patient with cHL during and after treatment.