Strategies in the treatment of Hodgkin's disease

The current treatment methods for the four stages of the four histologic subtypes of Hodgkin's disease are described. In the last several years, the use of radiotherapy and combination chemotherapy has dramatically improved the prognosis of patients with even the most advanced stages of disease. However, toxicity remains a problem. Gonadal function is adversely affected in many patients, and the risk of subsequent acute leukemia or myelodysplastic syndrome is about 10% at 10 years after treatment. There have been few trials of biologic response modifiers in Hodgkin's disease, and the results show no advantage over chemotherapy and radiotherapy. Newer therapeutic approaches will need to be devised, both to reduce toxicity and to improve the response of the relatively small number of patients who do not achieve a durable remission with present treatment.