[Treatment strategy for classical Hodgkin lymphoma and future perspectives]

Classical Hodgkin lymphoma (cHL) is a potentially curable disease, with initial therapy achieving long-term remission in approximately 85% of patients with limited-stage and 70% with advanced-stage disease. In limited-stage cHL, treatment strategies are determined based on risk stratification: early favorable disease is treated with ABVD for 2 cycles followed by involved-site radiation therapy (ISRT) of 20 Gy, and early unfavorable disease with ABVD for 4 cycles plus ISRT of 30 Gy. For advanced-stage cHL, 6 cycles of brentuximab vedotin plus AVD (BV-AVD) is the standard of care, while ABVD remains a viable option in elderly patients due to its more favorable tolerability profile. Recent large-scale clinical trials have demonstrated the efficacy of novel front-line regimens incorporating BV or immune checkpoint inhibitors, as well as interim PET-adapted strategies. These findings are driving a shift in treatment paradigms, with growing emphasis on treatment de-escalation and toxicity reduction in patients with favorable early response. This review provides an overview of current front-line treatment strategies for cHL, highlights ongoing challenges, and discusses future directions for therapy optimization.