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  • Review Article
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Treatment of Hodgkin lymphoma: the past, present, and future

Nature Clinical Practice Oncology volume 5, pages 543–556 (2008)Cite this article

Abstract

Significant advances in the biology and treatment of Hodgkin lymphoma (HL) have been accomplished over the past decades. In a landmark study, DeVita and colleagues showed that half of patients with advanced-stage HL experienced long-term disease-free survival following treatment with a four-drug chemotherapy regimen. Subsequent reports and randomized clinical trials conducted over the past 40 years have defined prognostic categories and refined the treatment options for patients with early-stage and advanced-stage HL. New treatment concepts and regimens have continued to increase the cure rate of HL, while other analyses have documented the acute and long-term morbid and potentially fatal side effects of HL therapy. Increased knowledge of HL biology has been gained, in particular, much has been learnt about the genetic and phenotypic characteristics of malignant cells and the varied oncogenic signaling pathways involved in HL. Continued translational research is needed to improve the long-term survival and to lessen the toxicities associated with therapy. Furthermore, continued clinical-trial involvement by oncologists and patients is imperative to further advance the field of HL.

Key Points

  • Preclinical translational studies have demonstrated that the Reed-Sternberg cells of classical Hodgkin lymphoma (HL) and the lymphocytic and histiocytic cells of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) are derived from B-cell origins and that several anti-apoptotic signaling pathways are involved in the survival of these malignant cells

  • Patients with stage I–II, (i.e. 'early stage') HL should usually be treated with combined-modality therapy comprising chemotherapy (ABVD) followed by involved-field radiotherapy

  • Chemotherapy alone is a treatment option for early-stage HL, especially where the risks of acute and/or long-term radiotherapy are deemed unacceptable

  • At present, ABVD is the internationally accepted standard regimen for advanced-stage HL, and is the regimen against which all experimental combinations should be tested; other chemotherapy programs such as Stanford V, and the more-intensive regimen, BEACOPP, represent treatment options for HL and data from randomized trials continues to be analyzed

  • Acute treatment-related toxicities (i.e. bleomycin-associated lung toxicity) and chronic treatment-related toxicities (secondary cancers, cardiovascular disease) should be considered when therapy choices are made, especially when treating HL in elderly patients

  • For advancement in the outcome of HL, it is imperative that international collaborative efforts continue and that oncologists offer all patients with HL the opportunity to participate in clinical trials

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Figure 1: The lost B-cell identity of Hodgkin/Reed-Sternberg (H-RS) cells.

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Authors and Affiliations

  1. AM Evens is Assistant Professor of Medicine at the Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine and the Robert H Lurie Comprehensive Cancer Center, Chicago, IL, USA,

    Andrew M Evens

  2. M Hutchings is Specialist Registrar at the Departments of Oncology and Haematology, Copenhagen University Hospital, Copenhagen, Denmark,

    Martin Hutchings

  3. Department of Internal Medicine, V Diehl is Chairman of the German Hodgkin Study Group, University of Cologne, Cologne, Germany.,

    Volker Diehl

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  1. Andrew M Evens
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  2. Martin Hutchings
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  3. Volker Diehl
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Correspondence to Andrew M Evens.

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Evens, A., Hutchings, M. & Diehl, V. Treatment of Hodgkin lymphoma: the past, present, and future. Nat Rev Clin Oncol 5, 543–556 (2008). https://doi.org/10.1038/ncponc1186

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