Treatment of unfavorable prognosis early (stage I-II) classical Hodgkin lymphoma
- Richard T Hoppe, MD
Richard T Hoppe, MD
- Professor of Radiation Oncology
- Stanford University School of Medicine
- Peter M Mauch, MD
Peter M Mauch, MD
- Professor of Radiation Oncology
- Harvard Medical School
- Ann S LaCasce, MD
Ann S LaCasce, MD
- Assistant Professor of Medicine
- Harvard Medical School
Once the diagnosis of Hodgkin lymphoma (HL, formerly called Hodgkin's disease) has been established, subsequent therapy and prognosis are based upon the stage of the disease, as currently defined by the Ann Arbor staging system with Cotswolds modifications (table 1). (See "Staging and prognosis of Hodgkin lymphoma" and "Overview of the treatment of classical Hodgkin lymphoma in adults".)
In this discussion, early stage HL is defined as those patients with stage I or II disease:
●Stage I – Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE)
●Stage II – Involvement of two or more lymph node regions on the same side of the diaphragm alone (II) or with involvement of limited, contiguous extralymphatic organ or tissue (IIE)
Among patients with early (stage I-II) disease, there is subsequent stratification into favorable and unfavorable prognosis disease based upon the presence or absence of certain clinical features, such as age, B symptoms, erythrocyte sedimentation rate (ESR), large number of regions involved, and large mediastinal adenopathy. Cooperative research groups have used varying definitions of favorable and unfavorable prognosis disease. These are described in more detail separately. (See "Staging and prognosis of Hodgkin lymphoma", section on 'Favorable or unfavorable risk early stage disease'.)
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- PRETREATMENT EVALUATION
- INITIAL THERAPY
- Choice of therapy
- Combined modality therapy
- - Chemotherapy regimen
- - Number of cycles
- - Radiation field size
- - Radiation dose
- Is there a role for chemotherapy alone?
- SPECIAL SCENARIOS
- Pregnant women
- Older adults
- HIV-infected patients
- Infradiaphragmatic disease
- Nodular lymphocyte predominant Hodgkin lymphoma
- PATIENT FOLLOW-UP
- CLINICAL TRIALS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS