Hodgkin Lymphoma: Recent Progress in Overall Management

Tarec Christoffer El-Galaly, MD; Anne Segolène Cottereau, MD; Adalgisa Condoluci, MD; Davide Rossi, MD, PHD; Jan Maciej Zaucha, MD, PHD; Anna Sureda, MD, PHD; Bruce Cheson, MD; Andrea Gallamini, MD

doi:10.36255/exon-publications.lymphoma.2021.management

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Published: Dec 28, 2021

DOI: https://doi.org/10.36255/exon-publications.lymphoma.2021.management

Keywords:

CD47 checkpoint, circulating tumor DNA, immune checkpoint inhibitors, management of Hodgkin lymphoma, PET/CT for lymphoma

Tarec Christoffer El-Galaly, MD

Hematology Department, Aalborg University Hospital, Denmark

Anne Segolène Cottereau, MD

Nuclear Medicine Department Cochin Hospital, Paris, France

Adalgisa Condoluci, MD

Laboratory of Experimental Hematology, Institute of Oncology, Bellinzona, Switzerland

Davide Rossi, MD, PHD

Clinic of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

Jan Maciej Zaucha, MD, PHD

Department of Hematology and Bone marrow Transplant, Medical University, Gdansk, Poland

Anna Sureda, MD, PHD

Clinical Hematology Department Catalan Institute of Oncology - Hospitalet, Barcelona, Spain

Bruce Cheson, MD

Scientific advisory board Lymphoma Research Foundation, New York, NY, USA

Andrea Gallamini, MD

Research and clinical innovation department, Antoine Lacassagne Cancer Center, Nice, France

ABSTRACT

The overall approach to the management of Hodgkin lymphoma has undergone a rapid revolution. The Ann Arbor staging, proposed more than half a century ago, is still valid to guide treatment intensity, but all the invasive methods originally proposed have been replaced by a single high-performing tool of functional imaging: the Positron Emission Tomography coupled with Computed-Tomography (PET/CT). Apart from improving the overall accuracy of the Ann Arbor staging, new PET-derived metrics to measure the tumor burden such as metabolic tumor volume, total lesion glycolysis and tumor spread such as the Tumor Distance (Dmax), are ready to take over the classical four-level lymphoma staging. PET/CT has also downsized the role of radiation in the classic “combined modality treatment” for HL. PET/CT performed early during treatment (interim PET) for advanced-stage HL remains the standard of care in Europe to escalate treatment in patients starting with ABVD or to de-escalate treatment for patients starting with BEACOPP escalated. Finally, the therapeutic offer for patients failing first-line chemotherapy has been completely renewed by the advent of new non-chemotherapy agents such as Brentuximab Vedotin and Immune Checkpoint Inhibitors (CPI) which are now the standard of care along with autologous stem cell transplant (ASCT).

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Lymphoma

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