Initial Management of Hodgkin Lymphoma

Initial Workup and Staging

• The European Society for Medical Oncology recommends complete blood count with differential to assess for cytopenias in patients with Hodgkin lymphoma 1, 4
• The American Society of Hematology suggests serum albumin and LDH as prognostic markers and indicators of tumor burden in patients with Hodgkin lymphoma 1, 4
• The National Comprehensive Cancer Network recommends erythrocyte sedimentation rate (ESR) for risk stratification in patients with Hodgkin lymphoma 1
• The Centers for Disease Control and Prevention advises HBV, HCV, and HIV serology as these infections impact treatment decisions in patients with Hodgkin lymphoma 1, 4
• The American College of Obstetricians and Gynecologists recommends pregnancy test in women of fertile age before therapy initiation in patients with Hodgkin lymphoma 1, 2

First-Line Treatment Strategy

• The National Cancer Institute recommends combined modality therapy with ABVD chemotherapy followed by involved-field radiotherapy (30 Gy) as the standard approach for early-stage disease (Stages I-II) in patients with Hodgkin lymphoma 1, 8, 9
• The European Society for Medical Oncology suggests full-term chemotherapy with ABVD (typically 6-8 courses) for advanced-stage disease (Stages III-IV) in patients with Hodgkin lymphoma 1, 8, 9

Response Assessment

• The American Society of Clinical Oncology recommends early evaluation of response with FDG-PET scan to guide treatment modifications in patients with Hodgkin lymphoma 1, 8

Relapsed or Refractory Disease

• The American Society of Hematology recommends high-dose chemotherapy followed by autologous hematopoietic stem cell transplant as the standard of care for patients with relapsed or refractory disease in patients with Hodgkin lymphoma 1, 8

Critical Pitfalls to Avoid

• The National Comprehensive Cancer Network advises against using radiotherapy alone for early-stage disease, as combined modality therapy has proven superior survival outcomes in patients with Hodgkin lymphoma 2, 3
• The European Society for Medical Oncology recommends against adding adjuvant radiotherapy to patients with advanced disease who achieve complete remission without initial bulk, as this increases toxicity without survival benefit in patients with Hodgkin lymphoma 1