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.

In most cases, treatment within the scope of one of the GHSG’s first-line trials is recommended.

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. For intermediate stage patients over 60 years of age treated outside clinical trials, the current standard treatment is 4 cycles of the A(B)VD regimen, followed by radiotherapy (30 Gy IF).

Advanced stage patients (stage IIB with extranodal involvement and/or large mediastinal mass as risk factors and stage III and IV) usually receive 6 cycles of chemotherapy, which takes about 45 months. The GHSG standard for patients aged between 18 and 60 years who are not treated within clinical trials is 6 cycles of the escalated BEACOPP regimen, plus 30 Gy IF radiotherapy in case of PET-positive residual tumors ≥ 2.5 cm.

For advanced stage patients over 60 years of age who are not treated within clinical trials, the current treatment standard is 68 cycles of the A(B)VD regimen, followed by radiotherapy (30 Gy) in case of residual tumors ≥ 1.5 cm, depending on the tumor response and side-effects of therapy.

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) without a preceding chemotherapy.

Should the disease not respond to chemotherapy or should it recur (relapse), about 50% of these patients can be cured with another, more intensive high-dose chemotherapy, followed by transplantation of the patient’s own (autologous) stem cells. In Germany, these patients receive two cycles of the DHAP regimen and the BEAM high-dose chemotherapy regimen thereafter. If this kind of treatment cannot be applied for medical reasons or should the patient experience another relapse, the therapeutic approach will be planned on an individual basis, taking the patient’s own wishes, concurrent diseases, previous therapies and the stage of disease into account. One of the options in such cases is as a targeted therapy with an immunotoxin. The antibodies administered in this type of therapy (by means of infusion) target the cancer cells. Once incorporated by the cancer cells, the immunotoxin prevents further cell division, eventually leading to the cells’ death.