Hodgkin's disease

There is overwhelming evidence that at least a substantial number of cases, if not all, of Hodgkin's disease (HD) represent monoclonal B-cell disorders. The treatment of HD is changing strikingly. In early stages of disease, extended field irradiation has been the standard resulting in excellent cure rates. Due to the recognition of fatal long-term effects, however, especially the high rates of second solid tumors, extended field radiotherapy is now being abandoned by most study groups. Instead, mild chemotherapy for control of occult disease is combined with involved field irradiation. In intermediate stage HD, where combined modality treatment is the treatment of choice, extended field irradiation is substituted by involved field irradiation for the same reasons. In advanced stage HD, 8 cycles of polychemotherapy (plus additional radiotherapy for large tumor masses and residual lymphomas) for decades has cured only 50% to 60% of patients. The development of a new dose-intensified regimen (BEACOPP) for the first time has significantly improved that prognosis. In relapsed HD, recently published phase III studies suggest an improvement of relapse-free survival of patients using high-dose chemotherapy followed by autologous stem cell transplantation (ASCT).