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Chemotherapy

Chemotherapy for treatment of Hodgkin lymphoma uses different types of drugs that either damage cells (cytotoxic drugs) or inhibit the growth of cells (cytostatic drugs). These drugs are usually combined (polychemotherapy) and administered according to internationally accepted treatment protocols that define the respective doses and chronological order of administration (cycles).

In Germany, the so-called ABVD regimen and the BEACOPP regimen are the most frequently used polychemotherapies. Every letter in their names stands for a certain cytotoxic or cytostatic drug, e.g. ABVD stands for doxorubicin, bleomycin, vinblastine and dacarbazine. A regimen is repeated until a defined number of cycles has been completed. After all cycles of chemotherapy have been administered, a radiotherapy is conducted if necessary. The kind of chemotherapy and number of administered cycles depends on the stage of disease and risk group of the patient.

For early stage patients (stage I or II without risk factors) who are not treated within the framework of clinical trials, 2 cycles of the ABVD regimen followed by radiotherapy (20 Gy IF) are recommended as standard treatment.

For intermediate stage patients (stage I and IIA with one ore more risk factors or stage IIB and a high erythrocyte sedimentation rate (ESR) as the only risk factor and/or with three or more involved lymph node areas), 4 cycles of chemotherapy (2 x escalated BEACOPP + 2 x ABVD) followed by radiotherapy (30 Gy IF) are recommended outside clinical trials.

Advanced stage patients (stage IIB with extranodal involvement and/or large mediastinal mass as risk factors, stage III and IV) usually receive 8 cycles of chemotherapy. This kind of treatment takes 6‑7 months. The GHSG standard for patients aged between 18 and 60 years who are not treated within clinical trials is the escalated BEACOPP regimen (a dose-intensified BEACOPP scheme), followed by 30 Gy IF radiotherapy (see below for more information) in case of PET-positive residual tumors ≥ 2.5 cm. At the moment the GHSG is conducting the HD18 trial for advanced stages.

For advanced stage patients over 60 years of age who are not treated within a clinical trial, the current standard treatment is 6–8 cycles of the ABVD regimen, depending on tumor response and side-effects. The GHSG’s trial for this group of patients is the AVD-Rev trial, which is open for recruitment.

Patients with nodular lymphocyte-predominant Hodgkin lymphoma at stage IA without risk factors form an exception and should not receive standard treatment. They usually have a very favorable prognosis and can be treated with radiotherapy alone (30 Gy IF, see below) without a preceding chemotherapy. In this connection, different trials investigated if the antibody rituximab can possibly be used instead of radiotherapy. Rituximab has already proven to be effective in the treatment of non-Hodgkin lymphomas. The respective trials will be analyzed soon.