How I treat advanced classical Hodgkin lymphoma

Abstract

The development of curative systemic treatment for Hodgkin lymphoma was recently voted one of the top 5 achievements of oncology in the last 50 years (http://cancerprogress.net/top-5-advances-modern-oncology). The high expectation of cure (above 80%) with initial therapy, even for advanced disease, is tempered by the recognition of some important limitations: not all patients are cured, especially among older age groups, and patients have suffered debilitating or in some cases fatal long term side effects. The challenge for modern treatment approaches is, if possible, to improve upon the high cure rates, whilst at the same time minimising the long term damage due to the treatment. After several decades in which we tested a variety of different ways to combine conventional cytotoxic treatments with or without radiotherapy, but identified no effective new approaches, the field is once again moving forward. The developments which hold the greatest promise in this respect are the application of functional imaging with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to make an early judgement of the success of treatment, and the introduction of some highly active new agents such as antibody-drug conjugates.