New trends in management of Hodgkin’s Lymphoma

Abstract

Hodgkin's lymphoma (HL) is a malignant tumor of the lymphatic system. It represents about 23% of all lymphomas in Egypt with incidence expressed in ASR (age standardized rate per 100,000) in Egypt is 2.5. HL divided into 2 main types: cHL and LPHL. cHL is characterized by the presence of Reed-Stemberg cells in an inflammatory background, whereas LPHL is characterized by the presence of lymphocytic and histiocytic cells. Advances in the study of the tumor microenvironment leads to the development of new modalities in the management of HL which are less toxic and more effective. Also the development of new imaging techniques such as PET and PET-CT scans which are recommended for initial staging and at the completion of therapy to assess treatment response, helps in the development of new modalities in the management of HL. Current management of HL involves initial treatment with chemotherapy or combined modality therapy, followed by restaging to assess treatment response. ABVD or Stanford V followed by consolidative IFRT is recommended for patients with stage l-ll favorable and unfavorable CHL. ABVD or Stanford V is also recommended for patients with stage III-IV disease who have bulky mediastinal adenopathy. Escalated BEACOPP is an option for high-risk patients with an IPS score of 4 or more. Consolidative RT to the mediastinum is recommended, especially if bulky mediastinal disease was present initially. For patients with progressive or relapsed disease, HDT/ASCR is the best treatment option although it does not improve OS. Second-line therapy (RT or conventional-dose second-line chemotherapy with or without RT) may be given prior to HDT/ASCR. There are many exciting therapies on the horizon for patients with advanced HL such as: Brentuximab vedotin Is an exciting new agent in the setting of relapsed HL and other lymphoid neoplasms CD30+ve. It has been included as an option for patients with progressive disease after HDT/ASCR or at least two prior chemotherapy regimens for all patients regardless of their eligibility for HDT/ASCR.