Risk-Adapted Approaches in Hodgkin Lymphoma

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Moderator, Peter L. Salgo, MD, introduces a panel discussion focused on the treatment of patients with Hodgkin lymphoma. This discussion covers a range of relevant issues and challenges, including best practices, treatment intricacies, and the future of treatment, including novel therapies and ongoing research. This discussion features perspectives from Jonathan W. Friedberg, MD, Paul A. Hamlin, MD, Craig H. Moskowitz, MD, and Lauren C. Pinter-Brown, MD.

To begin the conversation, Moskowitz describes that three broad categories exist in early-stage Hodgkin lymphoma: favorable, unfavorable, and bulky stage II. The standard treatment for these patients is a combined modality of radiation and chemotherapy. However, risk-adapted approaches are being examined that eliminate radiation as part of the primary management of the disease, due to concerns over long-term side effects. The lifelong risk of toxicity is an important concern for physicians who treat this disease, since it is generally diagnosed at a young age, Friedberg explains.

The RAPID study, presented at the ASH Annual Meeting, compared chemotherapy alone to the combination of radiation and chemotherapy in 602 patients with early-stage Hodgkin lymphoma. Of these patients, 91% of those receiving chemotherapy alone were without disease at 4 years compared to 97% for the combination. The big question, Moskowitz asks, is whether a 6% overall difference is a significant enough benefit to warrant the added risk of toxicities.