Advanced Stage Hodgkin Lymphoma: A Review on Frontline Treatment Advances

Before 1970, Hodgkin lymphoma (HL) was an often-fatal lymphoma treated with radiation and/or single-agent chemotherapy. In contrast, HL is now a largely curable disease treated with multiagent chemotherapy regimens. In the intervening half-century, the goal of HL treatment has evolved from improving cure rates to developing novel treatment paradigms that maintain historical efficacy while minimizing the short- and long-term side effects of intensive chemo- and radiation therapies. The development of PET-adapted escalation and de-escalation strategies has played a critical role in balancing the desired efficacy with toxicity. More recently, novel therapies including brentuximab vedotin and nivolumab have resulted in dramatic improvements in outcomes and a necessary reduction in toxicity in both pediatric and adult patients. Future efforts to improve short- and long-term toxicities through novel therapies and collaborative efforts between adult and pediatric groups will be essential as we seek to improve outcomes in patients with advanced-stage HL.