PETER(JOHNSON((SOUTHAMPTON)(
(
IS(THERE(STILL(A(ROLE(FOR(COMBINED(MODALITY(THERAPY(FOR(EARLY(
STAGE(CLASSICAL(HODGKIN(LYMPHOMA?(?(CON(
!
University(of(Southampton,(UK(
!
Treatment! of! classical! Hodgkin! Lymphoma! has! been! refined! over! the! last! 50! years,! with! a!
progressive! improvement! in! long! term! cure! rates! following! the! use! of! combined! modality!
chemotherapy! and! radiotherapy! regimens.! However,! a! minority! of! survivors! experience!
severe!morbidity!and!mortality,!particularly!resulting!from!the!use!of!radiotherapy!which!can!
lead!to!accelerated!cardiovascular!disease!and!second!primary!malignancies.!!!Whether!this!
may!be!avoided!by!the!use!of!chemotherapy>only!regimens!has!been!the!subject!of!several!
important!trials,!most!recently!using!FDG>PET!scanning!to!stratify!patients!into!those!most!
likely!to!have!been!cured!at!the!completion!of!the!chemotherapy,!or!those!evidently!in!need!
of! more! treatment.! ! The! results! of! these! studies! will! be! discussed,! in! particular! with!
reference!to!the!groups!of!patients!who!have!most!to!gain!by!avoiding!irradiation.!!Looking!
forward,!the!immune!checkpoint!blocking!antibodies!hold!the!promise!of!very!high!response!
rates! when! given! as! part! of! initial! therapy,! and! these! may! once! again! tip! the! balance! of!
benefit!versus!risk!in!favour!of!new!regimens!using!systemic!treatment!alone.!
!
References:(
Radford! J,! Illidge! T,! Counsell! N,! et! al.! Results! of! a! trial! of! PET>directed! therapy! for! early>stage!
Hodgkin's!lymphoma.!N!Engl!J!Med!2015;372(17):1598>607!!
doi:!10.1056/NEJMoa1408648.!
!
Andre! MPE,! Girinsky! T,! Federico! M,! et! al.! Early! Positron! Emission! Tomography! Response>Adapted!
Treatment!in!Stage!I!and!II!Hodgkin!Lymphoma:!Final!Results!of!the!Randomized!EORTC/LYSA/FIL!H10!
Trial.!J!Clin!Oncol!2017;35(16):1786>94!doi:10.1200/JCO.2016.68.6394!
!
Cottereau!AS,!Versari!A,!Loft!A,!et!al.!Prognostic!value!of!baseline!metabolic!tumor!volume!in!early!
stage!Hodgkin!lymphoma!in!the!standard!arm!of!the!H10!trial.!Blood!2018;131(13):1456>63!!
doi:!10.1182/blood>2017>07>795476!
!
Fuchs!M,!Goergen!H,!Kobe!C!et!al.,!Positron!Emission!Tomography>Guided!Treatment!in!Early>Stage!
Favorable!Hodgkin!Lymphoma:!Final!Results!of!the!International,!Randomized!Phase!III!HD16!Trial!by!
the!German!Hodgkin!Study!Group.!!J!Clin!Oncol.!2019;37(31):2835>2845.!!
doi:!10.1200/JCO.19.00964.!
!
Barrington! SF,! Phillips! EH,! Counsell! N,! et! al.,! Positron! Emission! Tomography! Score! Has! Greater!
Prognostic! Significance! Than! Pretreatment! Risk! Stratification! in! Early>Stage! Hodgkin! Lymphoma! in!
the!UK!RAPID!Study.!!
J!Clin!Oncol.!2019;37(20):1732>1741.!doi:!10.1200/JCO.18.01799.!!
!
Allen!PB,!Savas!H,!Evens!AM,!et!al.,!Pembrolizumab!followed!by!AVD!in!untreated!early!unfavorable!
and!advanced!stage!classical!Hodgkin!lymphoma.!!!
Blood.!2020:!blood.2020007400.!doi:!10.1182/blood.2020007400.!
! !