Although advanced Hodgkin lymphoma is highly curable, balancing the high cure rate with long-term toxicity is challenging. ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, dacarbazine) is the standard chemotherapy regimen, producing a high cure rate with acceptable toxicity. Stanford V and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) are new regimens with encouraging results and are undergoing randomized clinical trials. The International Prognostic Score provides a clinical tool that may help identify patients with high-risk disease who may require a more aggressive regimen. Consolidative radiation's role in managing advanced Hodgkin lymphoma is still controversial, but it is most accepted for bulky or residual disease or after brief chemotherapy. The development and integration of newer imaging tools, such as fluorodeoxyglucose–positron emission tomography imaging, may allow a more precise evaluation of disease and help define which patients might benefit from consolidative treatment.
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Correspondence: Ranjana Advani, MD, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305. E-mail: email@example.com
HancockBWVaughan HudsonGVaughan HudsonB. British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease—long term results. Br J Cancer1991;63:579–582.
GlickJHYoungMLHarringtonD. MOPP/ABV hybrid chemotherapy for advanced Hodgkin's disease significantly improves failure-free and overall survival: the 8-year results of the intergroup trial. J Clin Oncol1998;16:19–26.
HorningSJHoppeRAdvaniR. Efficacy and late effects of Stanford V chemotherapy and radiotherapy in untreated Hodgkin's disease: mature data in early and advanced stage patients [abstract]. Blood2004;104Abstract 308.
YahalomJEdwards-BennetSJacobsJ. Stanford V and radiotherapy for advanced and locally extensive Hodgkin's disease (HD): the Memorial Sloan-Kettering Cancer Center (MSKCC) experience [abstract]. Blood2003Abstract 1459.
HorningSJWilliamsJBartlettNL. Assessment of the Stanford V regimen and consolidative radiotherapy for bulky and advanced Hodgkin's disease: Eastern Cooperative Oncology Group Pilot Study E1492. J Clin Oncol2000;18:972–980.
JohnsonPHoskinPHorwichA. Stanford V (SV) regimen versus ABVD for the treatment of advanced Hodgkin lymphoma (HL): results of a UK NCRI/LTO randomised phase II trial [abstract]. Blood2004;104Abstract 311.
GobbiPGLevisAChisesiT. ABVD versus modified Stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. J Clin Oncol2005;23:9198–9207.
DiehlVBrillantCFranklinJ. BEACOPP chemotherapy for advanced Hodgkin's disease: results of further analyses of the HD9- and HD12-trials of the German Hodgkin Study Group (GHSG) [abstract]. Blood2004;104Abstract 307.
SieberMBredenfeldHJostingA. 14-day variant of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone regimen in advanced-stage Hodgkin's lymphoma: results of a pilot study of the German Hodgkin's Lymphoma Study Group. J Clin Oncol2003;21:1734–1739.
FedericoMBelleiMBriceP. High-dose therapy and autologous stem-cell transplantation versus conventional therapy for patients with advanced Hodgkin's lymphoma responding to front-line therapy. J Clin Oncol2003;21:2320–2325.
ProctorSJMackieMDawsonA. A population-based study of intensive multi-agent chemotherapy with or without autotransplant for the highest risk Hodgkin's disease patients identified by the Scotland and Newcastle Lymphoma Group (SNLG) prognostic index. A Scotland and Newcastle Lymphoma Group study (SNLG HD III). Eur J Cancer2002;38:795–806.
LoefflerMBrosteanuOHasencleverD. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. International Database on Hodgkin's Disease Overview Study Group. J Clin Oncol1998;16:818–829.
FermeCSebbanCHennequinC. Comparison of chemotherapy to radiotherapy as consolidation of complete or good partial response after six cycles of chemotherapy for patients with advanced Hodgkin's disease: results of the groupe d'etudes des lymphomes de l'Adulte H89 trial. Blood2000;95:2246–2252.
LaskarSGuptaTVimalS. Consolidation radiation after complete remission in Hodgkin's disease following six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy: is there a need?J Clin Oncol2004;22:62–68.
FriedbergJWFischmanANeubergD. FDG-PET is superior to gallium scintigraphy in staging and more sensitive in the follow-up of patients with de novo Hodgkin lymphoma: a blinded comparison. Leuk Lymphoma2004;45:85–92.
WirthASeymourJFHicksRJ. Fluorine-18 fluorodeoxyglucose positron emission tomography, gallium-67 scintigraphy, and conventional staging for Hodgkin's disease and non-Hodgkin's lymphoma. Am J Med2002;112:262–268.
SpaepenKStroobantsSDupontP. Can positron emission tomography with [(18)F]-fluorodeoxyglucose after first-line treatment distinguish Hodgkin's disease patients who need additional therapy from others in whom additional therapy would mean avoidable toxicity?Br J Haematol2001;115:272–278.