Modern treatment of Hodgkin lymphoma

The present review summarizes the current therapies and controversies in the management of newly diagnosed and relapsed classical and lymphocyte predominant Hodgkin lymphoma and briefly describes novel agents in development for Hodgkin lymphoma.

Early restaging fluoro-2-deoxy-D-glucose-positron emission tomography scans appear to provide important prognostic information, particularly in patients with advanced stage Hodgkin lymphoma. A persistently positive scan after two cycles of chemotherapy appears to predict a very dismal outcome, whereas a negative interim scan predicts a very favorable outcome. This finding provides an opportunity to study the effect of tailoring therapy early in the course of disease, perhaps shortening therapy and avoiding radiotherapy in early stage patients with a negative interim scan and escalating therapy in those with positive scans. Recent retrospective studies show it is safe to administer the standard doxorubicin, bleomycin, vinblastine, dacarbazine chemotherapy regimen, prescribed for nearly all patients with Hodgkin lymphoma, at full dose, on schedule without growth factors, minimizing the risk of bleomycin lung toxicity and perhaps improving outcome. Several new drugs are showing promise for refractory Hodgkin lymphoma, including the immunotoxin SGN-35 and the histone deacetylase inhibitor MGCD0103. Rituximab is being studied for the treatment of both classical and lymphocyte predominant Hodgkin lymphoma.

Current trials employing risk-adapted therapy on the basis of interim fluoro-2-deoxy-D-glucose-positron emission tomography scans have the potential of improving outcomes for all patients with Hodgkin lymphoma, either by improving cure rates, minimizing toxicity, or both.