Treatment of Classical Hodgkin Lymphoma Stage IIIB

Primary Treatment Approach

The American Society of Clinical Oncology recommends 6 cycles of ABVD chemotherapy alone, with radiotherapy reserved only for PET-positive residual disease ≥2.5 cm after completion of chemotherapy, for patients with Classical Hodgkin Lymphoma Stage IIIB 1, 2
For patients ≤60 years with advanced-stage disease, ABVD for 6 cycles represents the standard of care, with a regimen consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine, which can cause cardiotoxicity, pulmonary toxicity, and myelosuppression 1, 2, 3

The European Society for Medical Oncology suggests that BEACOPPesc (4-6 cycles) is an alternative first-line option for patients ≤60 years who are candidates for more intensive therapy, but should NOT be used in patients >60 years due to excessive toxicity 1, 2, 3, 5, 6

The National Comprehensive Cancer Network recommends that radiotherapy is NOT routinely given after chemotherapy for advanced-stage disease, but should be restricted to patients with PET-positive residual lymphoma ≥2.5 cm after completing 4-6 cycles of BEACOPPesc, with a dose of 30 Gy involved-site radiotherapy (ISRT) 1, 2, 3, 5, 6

The International Society for Geriatric Oncology recommends that ABVD-based chemotherapy represents the standard of care for older patients fit enough for multi-agent chemotherapy, with critical modifications including discontinuing bleomycin after cycle 2 to minimize pulmonary toxicity risk 1, 2, 3, 4, 5, 6

The American Society of Clinical Oncology suggests that baseline pulmonary function tests should be obtained before treatment, and bleomycin should be discontinued immediately if pulmonary symptoms develop, due to the high risk of life-threatening pulmonary toxicity 1, 2, 3
The European Society of Cardiology recommends that baseline cardiac function assessment is mandatory, due to the cumulative dose-dependent cardiotoxicity caused by doxorubicin 1, 2, 3