Primary Management of Advanced Hodgkin Lymphoma

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The cure rate for patients who present with advanced Hodgkin lymphoma is significantly lower than those with early-stage disease. However, the standard front-line chemotherapeutic regimen is the same for both groups: ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine).

The major difference in the management of early and advanced disease, Jonathan W. Friedberg, MD, notes, is the acceptance that radiation therapy plays a minimal role in the treatment of advanced disease. For these patients, a cure, which occurs in approximately 70% of cases, relies heavily on chemotherapeutic approaches.

In the advanced setting, the spread of the disease obfuscates the affects of radiation. Moreover, the leading cause of mortality in Hodgkin lymphoma is from pulmonary involvement in multiple nodules. In general, Craig H. Moskowitz, MD, implies, it does not make sense to use radiation therapy in this setting.

The first priority in the management of Hodgkin lymphoma is to cure the disease, Friedberg emphasizes. In early-stage disease, the high cure rate has allowed the luxury of focusing on maximizing quality of life during and after treatment. However, unfortunately, this is not always the case in advanced disease.