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Adult Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Early Favorable Hodgkin Lymphoma

Drug combinations described in this section include the following:

Patients are designated as having early favorable Hodgkin lymphoma (HL) if they have clinical stage I or stage II disease and no adverse risk factors. Adverse risk factors include the following:

Recommended Related to Non-Hodgkin's Lymphoma

Understanding Non-Hodgkin Lymphoma -- the Basics

Lymphoma refers to a malignancy of the lymphatic system. The lymphatic system is a network of nodes (knots of tissue) connected by vessels. Together, the lymph nodes drain fluid and waste products from the body. The lymph nodes act as tiny filters, removing foreign organisms and cells. Lymphocytes, are a type of white blood cell that helps fight infections caused by bacteria, viruses, or fungi. The lymph node function is to prevent infections from entering the bloodstream. When the lymphatic...

Read the Understanding Non-Hodgkin Lymphoma -- the Basics article > >

  • B symptoms (fever ≥38°C, soaking night sweats, weight loss ≥10% within 6 months). (Refer to the PDQ summary on Fever, Sweats, and Hot Flashes for more information.)
  • Extranodal disease.
  • Bulky disease (≥10 cm or >33% of the chest diameter on chest x-ray).
  • Three or more sites of nodal involvement.
  • Sedimentation rate ≥50 mm/h.

Historically, radiation therapy alone had been the primary treatment for patients with early favorable HL, often after confirmatory negative staging laparotomy. A randomized, prospective trial involving 542 patients with early favorable HL compared MOPP-ABV for three cycles plus involved-field radiation therapy (IF-XRT) with subtotal nodal radiation; with a median follow-up of 7.7 years, combined modality was favored in terms of 5-year event-free survival (98% vs. 74%, P < .001) and 10-year overall survival (97% vs. 92%, P = .001).[1][Level of evidence: 1iiA] The late mortality from solid tumors, especially in the lung, breast, gastrointestinal tract, and connective tissue, and from cardiovascular disease makes radiation therapy a less attractive option for the best-risk patients, who have the highest probability of cure and long-term survival.[2,3,4,5,6] Recent clinical trials have focused on regimens with chemotherapy and IF-XRT or with chemotherapy alone.[7]

A randomized, prospective trial from the National Cancer Institute of Canada involving 123 patients with early favorable HL compared ABVD for four to six cycles to subtotal nodal radiation; with a median follow-up of 11.3 years, no difference was observed in event-free survival (89% vs. 86%; P = .64) or in overall survival (OS) (98% vs. 98%; P = 0.95).[8][Level of evidence: 1iiA]

In a randomized study from the Milan Cancer Institute of patients with clinical early-stage HL, 4 months of ABVD followed by either IF-XRT or extended-field radiation therapy (EF-XRT) showed similar OS and freedom-from-progression with a 10-year median follow-up, but the study had inadequate statistical power to determine noninferiority of IF-XRT versus EF-XRT.[9][Level of evidence: 1iiDii]

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