Updated treatment recommendations for Hodgkin lymphoma

HODGKIN lymphoma management continues to evolve through risk adapted and positron emission tomography (PET) guided treatment strategies tailored to disease stage, patient age, and treatment response.

Hodgkin lymphoma is a B cell derived malignancy that frequently affects young adults. Risk stratification is based on disease staging using PET and computed tomography (CT) alongside the presence or absence of recognised risk factors. This classification guides treatment intensity and subsequent management decisions.

For patients with early-stage favourable classic Hodgkin lymphoma, standard treatment consists of two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 20 Gy involved-site radiotherapy.

PET Guided Decisions in Early Disease

Patients aged 60 years or younger with early-stage unfavourable classic Hodgkin lymphoma should be considered for a more intensive approach consisting of two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, or a procarbazine-free variant, followed by two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine.

Subsequent treatment decisions are guided by PET and CT findings following chemotherapy. Patients with positive imaging results should receive 30 Gy involved site radiotherapy, while those with negative findings require no additional treatment.

Where a less intensive strategy is preferred, and for individuals older than 60 years, four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine followed by 30 Gy involved site radiotherapy may be used.

New Options for Advanced and Recurrent Disease

For advanced classic Hodgkin lymphoma in patients aged 60 years or younger, brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone should be considered for four or six cycles according to interim imaging findings after two cycles of therapy, followed by PET guided involved site radiotherapy.

Six cycles of nivolumab with doxorubicin, vinblastine, and dacarbazine represent a less intensive alternative for younger patients and the preferred treatment approach for patients older than 60 years.

Patients with recurrent classic Hodgkin lymphoma should receive salvage treatment containing a checkpoint inhibitor followed by high dose chemotherapy and autologous stem cell transplantation where appropriate and clinically feasible.

The recommendations also note that management of nodular lymphocyte predominant Hodgkin lymphoma differs from classic Hodgkin lymphoma in selected settings and may include treatment with an anti CD20 antibody.

Reference

Eichenauer DA et al. Hodgkin lymphoma: EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up. HemaSphere. 2026;10(6):e70422.

Featured image: ckybe on Adobe Stock.