Early intensification treatment approach in advanced-stage Hodgkin lymphoma

The key question in advanced-stage Hodgkin lymphoma for many years now has been, should intensified chemotherapy be applied upfront or be reserved for relapsing patients. The early intensification approach with BEACOPP(escalated) (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) aims at curing patients with first-line chemotherapy definitely. The added toxicity of this approach as compared to less intensive regimens as ABDV (doxorubicin, bleomycin, dacarbazine, vinblastine) is mainly restricted to acute haematotoxicity and gonadal damage. However, regarding efficacy, there is a meaningful survival-benefit over ABVD (10% at 5years) and the intensified first-line treatment strategy is thus rightly regarded as standard of care.