Progress in the initial management of Hodgkin's Lymphoma

Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups under the designation of classical HL. An accurate assessment of the stage of disease in patients with HL is critical for the selection of appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence are used to optimize therapy for patients with limited or advanced stage disease and predict their outcomes while reducing the toxicities. Initial therapy for HL patients is based on the histology, anatomical stage and the presence of poor prognostic features. Management of localized HL has shifted from radiation alone to combined modality strategies with brief courses of combination chemotherapy followed by involved-field radiation therapy. Patients with advanced stage disease receive a longer course of chemotherapy commonly without radiation therapy. Clinical trials are being conducted using the early interim response or response at the end of therapy as measured by PET scan to determine treatment.