Treatment of early stage Hodgkin lymphoma. Discussion of current trials and treatment recommendations

In early stage Hodgkin lymphoma (HL) the majority of patients can be cured using a risk-adapted combined modality treatment (CMT) strategy. However, treatment-associated toxicity significantly contributes to morbidity and mortality. Current trials hence aim at reducing treatment-associated toxicity, while maintaining or even improving tumor control. Review of the available data and development of current treatment recommendations for early stage favorable and unfavorable HL. Evaluation of results of current randomized trials, meta-analyses and relevant retrospective analyses. Because of the excellent survival rates (HD10) and the establishment of involved site (IS)-RT, two cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and 20aEuroGy IS-RT are regarded as standard in early stage favorable HL, while four cycles of ABVD and 30aEuroGy IF-RT result in progression-free survival (PFS) rates of up to 83% (HD11) is used in early stage unfavorable disease. A significant improvement of tumor control at the cost of increased acute toxicity was documented with two cycles of BEACOPP(escalated) (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) followed by two cycles of ABVD (2aEuro+ 2; HD14). A (18F)FDG-PET-based chemotherapy with two cycles of BEACOPP(escalated) applied in PET-positive patients after two cycles of ABVD (H10) might allow a reduction of treatment intensity in a relevant number of patients and provide favorable PFS; however, further data is required. Therefore, 2aEuro+ 2aEuro+ 30aEuroGy IS-RT is currently recommended as standard in patients < 60 years of age. The available data support consolidative RT for optimal disease control. But, omission of RT might be discussed in selected patients with PET-negative disease