Decision-making in the management of adult classical Hodgkin’s lymphoma: determining the optimal treatment

Abstract

This review discusses promising new approaches in classical Hodgkin’s lymphoma that have been recently evaluated. There is a focus on the fluorodeoxyglucose PET scanning that is now considered crucial for staging and treatment evaluation, including interim evaluation after two cycles. An up-front treatment strategy is discussed, with the place of radiation therapy and the difficult choice of chemotherapy intensity emphasized. Indications for frail patients are also reviewed, particularly elderly or HIV-positive patients. Emerging data on the antibody drug conjugate brentuximab vedotin and its future potential in the transplantation framework for relapsed/refractory Hodgkin’s lymphoma is also discussed.

Keywords:

• chemotherapy
• Hodgkin
• molecular profiles
• PET imaging
• targeted drugs
• transplantation

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Erratum

Acknowledgements

The authors thank C Druon for editing the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Staging with PET is the standard for Hodgkin’s lymphoma.

• A predictor of survival using gene expression measured in formalin-fixed paraffin-embedded biopsy is now under validation study.

• Monitoring the tumor response by interim evaluation with PET is a forthcoming standard.

• For a localized stage: which indication for radiation therapy in the interim PET era?

• For a disseminated stage: which indication for intensive chemotherapy in the interim PET era?

• Combining new drugs, such as brentuximab vedotin, is most likely the next challenge.

• Frail patients should be included in therapeutic trials of targeted drugs to replace chemotherapy and radiotherapy without losing efficacy.

Notes