Treatment of classical Hodgkin’s lymphoma Summary

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Early stage favorable Hodgkin’s lymphoma
·         HD 10 trial: NEJM 2010:
o   1370 pts, 4 arms:
§  4 cycles of ABVD followed by 30 Gy
§  4 cycles of ABVD followed by 20 Gy
§  2 cycles of ABVD followed by 30 Gy
§  2 cycles of ABVD followed by 20 Gy
o   No difference in freedom from treatment failure, OS at 5 yrs
o   2 cycles of ABVD followed by 20 Gy should be the new standard of care
Unfavorable characteristics
Bulky disease (>10 cm or 1/3 max. transverse thorax diameter
Extranodal site involvement
3 or more lymph node areas involved
ESR > 50 mm/h or > 30 mm/hr with B symptoms.
                                                                                                                                         
Early stage unfavorable Hodgkin’s lymphoma
·         HD 11 trial: JCO 2010
o   1395 pts, 4 arms:
§  4 cycles of ABVD followed by 30 Gy of IFRT
§  4 cycles of ABVD followed by 20 Gy of IFRT
§  4 cycles of BEACOPP followed by 30 Gy of IFRT
§  4 cycles of BEACOPP followed by 20 Gy of IFRT
o   BEACOPP more effective than ABVD when followed by 20 Gy  (FFTF, PFS, OS)
o   No difference between BEACOPP & ABVD when followed by 30 Gy (FFTF, PFS, OS)
o   After 4 cycles of BEACOPP 20 Gy was not inferior to 30 Gy
o   Inferiority can’t be excluded for 20 Gy after 4 cycles of ABVD when compared to 30 Gy
o   4 cycles of ABVD followed by 30 Gy of IFRT should be the standard of care
Advanced stage Hodgkin’s lymphoma
·         CALGB trial : NEJM 1992
o   361 pts, 3 arms:
§  MOPP for 6 to 8 cycles
§  MOPP alternating with ABV D for 12 cycles
§  ABVD for 6 to 8 cycles
o   ABVD alone was superior to MOPP alone in 5 yrs Failure free survival  and OS
o   ABVD alone was as effective as MOPP alternating with ABVD but less toxic

o   ABVD for 6 to 8 cycles should be the standard of care

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