Primary Therapy of Advanced Hodgkin

ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) continues to be the standard of care for patients with advanced-stage Hodgkin lymphoma (HL). Consolidation of primary chemotherapy with radiation or autologous stem cell transplantation (ASCT) has not demonstrated an improvement in overall survival in randomized controlled trials. Regimens such as escalated BEACOPP have more acute and late toxicities and survival benefits have yet to be confirmed. Despite effective therapy, ultimately 30 % to 40 % of patients with advanced HL will relapse. ASCT has become the standard of care for patients with relapsed or refractory HL based on two randomized trials. The optimal salvage chemotherapy and high dose therapy regimen are not known. Similarly, non-ASCT strategies including salvage radiotherapy or non-ASCT chemotherapy strategies have been reported and have a potential role in selected clinical scenarios. This review summarizes recent clinical trial results in the initial treatment of advanced HL and will focus on second-line treatment strategies for patients with relapsed or refractory disease. Hodgkin lymphoma (HL) is a highly curable diseasewith the majority of patients presenting withlocalized disease. Advanced HL (defined as presented with bulk> 10 cm, the presence of B symptoms and/or stage III/IV disease) has typically been associated with failure rates as high as 30 % to 40 % with anthracycline-based polychemotherapy. Trials have systematically evaluated multi-agent chemotherapy regimens and the use of consolidation strategies with a focus on improved disease control. Relapsed or refractory HL constitutes another common problem for clinicians who treat lymphoma. Second-line chemotherapy followed by autologous stem cell transplan-tation is the standard of care based on randomized trial data. However, there is a lack of consensus about the type of salvage chemotherapy employed prior to the transplant as well as the potential role of other strategies in non-trans-plant eligible patients