{"entity":{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","aka":[],"tldr":"Hodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab.","summary":"Classical Hodgkin lymphoma is a B-cell cancer in which rare, giant Reed-Sternberg cells (about 1% of the mass) recruit an inflammatory microenvironment and hide behind amplified PD-L1. It peaks in young adults and again after 55, is staged with PET-CT and the Lugano system, and is cured in more than 85% of patients overall and in over 90% of early-stage disease. Because most patients are young and will live for decades, the field's defining problem is not cure but the cost of cure: anthracycline heart disease, bleomycin lung injury, infertility, and second cancers from alkylators and radiation.\n\nThat is why Hodgkin lymphoma pioneered response-adapted therapy. Interim PET after two cycles (Deauville score) steers de-escalation (drop bleomycin after negative PET2 in RATHL; omit radiotherapy in early stage in HD16/HD17/RAPID at a small PFS cost) or escalation to BEACOPP-type regimens. Two ADC- and immunotherapy-based regimens then replaced ABVD for advanced disease: brentuximab vedotin-AVD (ECHELON-1, overall survival benefit) and, from March 2026, nivolumab-AVD (SWOG S1826, PFS HR 0.45 versus BV-AVD, neuropathy halved, children and adults together). In Europe, GHSG HD21's PET-guided BrECADD matches escalated BEACOPP's ~94% PFS with far less toxicity. Relapse is treated with PD-1 blockade (pembrolizumab beat brentuximab in KEYNOTE-204), brentuximab, salvage chemotherapy and autologous transplant, with brentuximab consolidation for high-risk patients (AETHERA); allogeneic transplant and CD30 CAR-T are options for the few who fail everything.\n\nThe next questions are how far chemotherapy can be removed. AHOD2131 tests brentuximab-nivolumab in early-stage disease across children and adults; ctDNA may replace PET for steering; older patients, who have half the cure rate of young ones, need regimens they can tolerate (nivolumab-AVD, brentuximab-based). Survivorship care for the tens of thousands cured decades ago, and the shift from radiotherapy to systemic de-escalation, remain the field's distinctive concerns.","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Hodgkin_lymphoma","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Hodgkin_lymphoma"},{"label":"Lymphoma Action: helpline services","url":"https://lymphoma-action.org.uk/information-and-support/support-you/helpline-services"},{"label":"Lymphoma Action: questions to ask your medical team about lymphoma","url":"https://lymphoma-action.org.uk/information-and-support/tests-scans-and-lymphoma-staging/questions-ask-your-medical-team-about-lymphoma"},{"label":"Lymphoma Action: follow-up after lymphoma treatment","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/follow-after-lymphoma-treatment"},{"label":"Lymphoma Action: infections, risk and prevention","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/infections-risk-and-prevention"},{"label":"Lymphoma Action: neutropenia (low neutrophils)","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/neutropenia-low-neutrophils"},{"label":"Lymphoma Action: cancer-related fatigue","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/cancer-related-fatigue"},{"label":"Lymphoma Action: lymphoma, work and you","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/day-day-living/lymphoma-work-and-you"},{"label":"Maggie's: support and information","url":"https://www.maggies.org/support-and-information/"},{"label":"Lymphoma Action: classical Hodgkin lymphoma","url":"https://lymphoma-action.org.uk/information-and-support/types-lymphoma/hodgkin-lymphoma/classical-hodgkin-lymphoma"},{"label":"Lymphoma Action: late effects of lymphoma treatment","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/late-effects-lymphoma-treatment"},{"label":"Lymphoma Action: annual breast screening missed following radiotherapy for Hodgkin lymphoma","url":"https://lymphoma-action.org.uk/news/annual-breast-screening-missed-following-radiotherapy-hodgkin-lymphoma"},{"label":"GOV.UK: protocols for surveillance of women at higher risk of developing breast cancer, NHS Breast Screening Programme","url":"https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/protocols-for-surveillance-of-women-at-higher-risk-of-developing-breast-cancer"},{"label":"Schaapveld et al., second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, New England Journal of Medicine 2015 (3,905 Dutch survivors)","url":"https://doi.org/10.1056/NEJMoa1505949"},{"label":"van Nimwegen et al., cardiovascular disease after Hodgkin lymphoma treatment, 40-year disease risk, JAMA Internal Medicine 2015 (2,524 Dutch patients)","url":"https://doi.org/10.1001/jamainternmed.2015.1180"},{"label":"NHS: Hodgkin lymphoma","url":"https://www.nhs.uk/conditions/hodgkin-lymphoma/"},{"label":"NHS: Hodgkin lymphoma, symptoms","url":"https://www.nhs.uk/conditions/hodgkin-lymphoma/symptoms/"},{"label":"NHS: Hodgkin lymphoma, treatment","url":"https://www.nhs.uk/conditions/hodgkin-lymphoma/treatment/"},{"label":"Macmillan: Hodgkin lymphoma","url":"https://www.macmillan.org.uk/cancer-information-and-support/lymphoma/hodgkin-lymphoma"},{"label":"Cancer Research UK: living with Hodgkin lymphoma","url":"https://www.cancerresearchuk.org/about-cancer/hodgkin-lymphoma/living-with"},{"label":"Macmillan: superior vena cava obstruction","url":"https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/superior-vena-cava-obstruction"},{"label":"WHO Classification of Haematolymphoid Tumours, 5th edition: lymphoid neoplasms (Alaggio, Leukemia 2022)","url":"https://doi.org/10.1038/s41375-022-01620-2"},{"label":"International Consensus Classification of Mature Lymphoid Neoplasms (Campo, Blood 2022)","url":"https://doi.org/10.1182/blood.2022015851"}],"tags":["heme","spike"],"related":["pd1-plus-avd-hodgkin","bleomycin-omission-caution","pd-ligand-9p24-alteration","lymphoma-roadmap","lymphoma-ev-radiotherapy-free-early-hodgkin","lymphoma-ev-late-effects-of-the-treatments-given-now"],"cancers":[],"sections":[],"technologies":["adc","checkpoint-inhibitor","fdg-pet","pet-adapted-therapy","autologous-stem-cell-transplant","ctdna-lymphoma-monitoring","cardio-oncology","imrt-igrt","proton-therapy","survivorship-care-plan","fertility-preservation","palliative-care","psycho-oncology","peer-support-groups","financial-navigation","cbt-fatigue-distress","exercise-during-chemotherapy","multidisciplinary-tumour-board","oncology-nutrition","prehabilitation","pet-ct","mammography","histopathology-ihc","cytogenetics-fish"],"targets":["pd1","cd30","pdl1","jak2","ciita","jak1","stat3","socs1","b2m"],"drugs":["carmustine","chlorambucil","dacarbazine","mechlorethamine","procarbazine","prednisone","palifermin","brentuximab-vedotin","nivolumab","pembrolizumab","doxorubicin","bleomycin","vinblastine","etoposide"],"companies":["haihe-biopharma","bms","merck","pfizer","takeda","swog","childrens-oncology-group","gbg"],"institutions":["cruk","mskcc","dana-farber"],"pathways":["pd1-checkpoint","jak-stat","tumor-microenvironment","antigen-presentation-immunoediting","oncogenic-viruses","myeloid-suppression-axis"],"terms":["deauville-score","reed-sternberg-cell","lugano-classification","pfs","os","lymphoma-tx-radiotherapy","lymphoma-tx-hodgkin-late-effects","lymphoma-tx-fertility-preservation","lymphoma-tx-transplant-role","lymphoma-tx-uk-versus-us","lymphoma-tx-uk-access","lymphoma-tx-regimen-alphabet","cancer-related-fatigue","late-effects","febrile-neutropenia","neutropenia","financial-toxicity","central-venous-access","hypogammaglobulinaemia","performance-status","quality-of-life","lymphoma-decision-beacopp-or-abvd","lymphoma-decision-fertility-timing","lymphoma-decision-trial","lymphoma-living-hodgkin-survivorship-screening","lymphoma-living-fatigue","lymphoma-living-scanxiety-and-surveillance","lymphoma-living-returning-to-work","lymphoma-living-vaccinations","secondary-malignancy","cardiotoxicity","deauville","lymphoma-bio-hodgkin-microenvironment","lymphoma-bio-ebv-latency","lymphoma-bio-lineage-antigen-cost","plasma-ebv-dna","lymphoma-classification-2022","lymphoma-b-versus-t-cell"],"trials":["ccss","nct07188558","nct04002297","nct06230224","rathl","echelon-1","swog-s1826","hd21","aethera","keynote-204","checkmate-205","ahod2131","hd10","hd16","hd18","ahl2011","eortc-h10","radar-hodgkin"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["hematological-oncology","journal-of-adolescent-and-young-adult-oncology"],"dependsOn":[],"notes":["Living with and after Hodgkin lymphoma, the decisions and the people who make them: This is orientation from public patient pages, guidelines and the trials themselves, not advice for your case: your own team's instructions and the 24-hour number they gave you come first, and no figure here is a prediction about you. The decision records, the question sets, the first 60 days checklist and the red cards on this page were written from the NHS, Lymphoma Action, Macmillan and Cancer Research UK patient pages, from NICE NG52, NG47, CG151 and NG234, from the NHS Breast Screening Programme protocols and the Green Book, and from the trial reports named beside each figure, all read on 1 October 2026.","On the forty-year figures. The second-cancer and cardiovascular cumulative incidences quoted on this page come from two Dutch cohorts treated between 1965 and 2000 with the radiotherapy fields and doses of that era, which are far larger than anything given now. They describe what happened to those cohorts. What modern fields and PET-guided de-escalation are worth over forty years is not yet known, because the cohort that would measure it has not been followed for forty years. The reason to carry the figures anyway is that the screening programmes attached to them are the thing a survivor can act on, and the commonest failure is not being enrolled in one.","Taxonomy. The two classifications of 2022 disagree about the name of the non-classical form. The International Consensus Classification renamed nodular lymphocyte predominant Hodgkin lymphoma to nodular lymphocyte predominant B-cell lymphoma by consensus, because it differs biologically and clinically from classic Hodgkin lymphoma and is closely related to T-cell/histiocyte-rich large B-cell lymphoma. WHO-HAEM5 kept the old name so as not to interfere with trials in progress, while stating that the new name is acceptable in preparation for adopting it. The corpus keeps the record under the WHO-HAEM5 name and carries the other as an alias. Both books leave the four subtypes of classic Hodgkin lymphoma unchanged and both note that with modern treatment those subtypes have lost most of their prognostic meaning."],"group":"haematologic","burden":"~83,000 new cases a year worldwide, ~8,500 in the US, with age peaks at 20-30 and over 55. More than 85% are cured, so the research agenda is curing with less toxicity. Five-year survival is ~89% overall in high-income countries; ~23,000 deaths a year worldwide.","subtypes":["Classical Hodgkin lymphoma: nodular sclerosis (most common in young adults), mixed cellularity, lymphocyte-rich, lymphocyte-depleted","Nodular lymphocyte-predominant B-cell lymphoma (reclassified 2022; indolent, CD20+, rituximab-responsive)","Early stage (I-II) favourable vs unfavourable (bulk, ESR, ≥3 sites)","Advanced stage (III-IV); IPS 0-7 risk score","Paediatric / adolescent-young-adult vs older (>60) disease","EBV-positive (more common in children, older adults, and low-income settings)"],"biomarkers":["Interim PET (Deauville)","CD30","PD-L1 (9p24.1 amplification)","Interim PET (Deauville score) after cycle 2","CD30 and CD15 on Reed-Sternberg cells; CD20 in NLPBL","9p24.1 (PD-L1/PD-L2) amplification","EBV status (EBER)","International Prognostic Score (IPS)","Baseline metabolic tumour volume","ctDNA (research; PhasED-seq)","Soluble CD30 (research)"],"standardOfCare":[{"setting":"Advanced stage","approach":"Nivolumab-AVD (2026) or BV-AVD; PET-adapted.","refs":["nivolumab","brentuximab-vedotin","fdg-pet"],"guideline":{"version":"NCCN Guidelines: Hodgkin Lymphoma","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1439"}},{"setting":"Early stage, favourable (I-II)","approach":"ABVD × 2 + involved-site radiotherapy 20 Gy (HD10), or PET-adapted omission of radiotherapy after 3 cycles if PET-negative (RAPID, HD16) accepting ~5% lower PFS; AHOD2131 tests BV-nivo.","refs":["doxorubicin","pet-adapted-therapy","imrt-igrt","deauville-score","ahod2131"],"guideline":{"nccn":"Category 1 (ABVD × 2 + ISRT 20 Gy or PET-adapted chemotherapy alone)","version":"NCCN Hodgkin Lymphoma 2026"}},{"setting":"Early stage, unfavourable (I-II bulky or risk factors)","approach":"ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.","refs":["doxorubicin","pet-adapted-therapy","imrt-igrt"],"guideline":{"nccn":"Category 2A","version":"NCCN 2026"}},{"setting":"Advanced stage (III-IV), age ≤60","approach":"Nivolumab-AVD × 6 (S1826; approved March 2026, no routine radiotherapy) or BV-AVD × 6 with G-CSF (ECHELON-1); in Europe PET-guided BrECADD × 4-6 (HD21) or eBEACOPP; PET-adapted ABVD/AVD (RATHL) where novel agents unavailable.","refs":["swog-s1826","nivolumab","echelon-1","brentuximab-vedotin","hd21","rathl","pd1-plus-avd-hodgkin"],"guideline":{"nccn":"Category 1 (nivolumab-AVD preferred; BV-AVD)","esmoMcbs":"A (ECHELON-1)","version":"NCCN 2026"}},{"setting":"Advanced stage, age >60","approach":"Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.","refs":["swog-s1826","nivolumab","brentuximab-vedotin","bleomycin-omission-caution"]},{"setting":"First relapse, transplant-eligible","approach":"Salvage (ICE, DHAP, GVD, BV-nivolumab or pembrolizumab-GVD) → PET-negative → high-dose therapy and autologous transplant; brentuximab consolidation for high-risk (AETHERA); PD-1 maintenance in trials.","refs":["autologous-stem-cell-transplant","brentuximab-vedotin","nivolumab","pembrolizumab","aethera"],"guideline":{"nccn":"Category 1 (ASCT after chemosensitive salvage; BV consolidation for high risk)","version":"NCCN 2026"}},{"setting":"Relapse after transplant or transplant-ineligible","approach":"Pembrolizumab (KEYNOTE-204) or nivolumab; brentuximab vedotin if not yet given; BV + nivolumab; allogeneic transplant for fit patients after response; CD30 CAR-T in trials; palliative radiotherapy or bendamustine.","refs":["pembrolizumab","keynote-204","nivolumab","checkmate-205","brentuximab-vedotin","idea-cd30-car-t-hodgkin"],"guideline":{"nccn":"Category 1 (pembrolizumab, nivolumab, brentuximab)","version":"NCCN 2026"}},{"setting":"Paediatric (COG / EuroNet)","approach":"Risk-adapted OEPA/COPDAC (EuroNet-PHL-C2) or ABVE-PC with brentuximab (AHOD1331, EFS benefit) and PET-guided radiotherapy omission; S1826 and AHOD2131 now enrol from age 12 or 5.","refs":["brentuximab-vedotin","pet-adapted-therapy","childrens-oncology-group","ahod1331","euronet-phl-c2"]},{"setting":"Survivorship","approach":"Lifelong surveillance for cardiac disease (anthracycline, mediastinal RT), breast cancer screening from 8 years after chest RT in women, thyroid and lung checks, fertility counselling before therapy.","refs":["cardio-oncology","mammography"]},{"setting":"Choosing treatment in Hodgkin lymphoma: stage, risk factors and the interim PET","approach":"Three inputs. Stage by PET-CT reported with the Lugano classification. Risk factors, which differ by group: the German Hodgkin Study Group counts a large mediastinal mass, extranodal disease, a raised erythrocyte sedimentation rate and three or more nodal areas; EORTC counts a large mediastinal mass, age 50 or over, a raised sedimentation rate and four or more nodal areas. And the interim PET after two cycles, scored 1 to 5 on the Deauville scale, which is used to intensify treatment in patients who have not responded and to reduce it in those who have.\n\nThat last step, PET adaptation, is the structural idea behind modern Hodgkin treatment. RATHL showed that bleomycin can be dropped from cycles 3 to 6 in patients whose PET after two cycles is negative, with three-year progression-free survival of 85.7 per cent for continued ABVD against 84.4 per cent for AVD, which removed lung toxicity from most patients' treatment. EORTC H10 showed the reverse direction: in patients whose early PET was positive, switching from ABVD to escalated BEACOPP with involved-node radiotherapy raised five-year progression-free survival from 77.4 to 90.6 per cent (hazard ratio 0.42).\n\nBefore the first cycle: lung function tests if bleomycin is planned, echocardiography, hepatitis B, hepatitis C and HIV testing, and a fertility conversation, which in a disease of young people is not optional.","refs":["rathl","deauville","deauville-score","fdg-pet","pet-adapted-therapy","lugano-classification","abvd-beacopp","lymphoma-tx-fertility-preservation","lymphoma-tx-hepatitis-b-reactivation"],"guideline":{"version":"NCCN Hodgkin Lymphoma; ESMO; RATHL, EORTC H10","url":"https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq"}},{"setting":"Survivorship after Hodgkin lymphoma: what the cure costs, and what is watched for","approach":"Most people treated for Hodgkin lymphoma are cured and then live for decades with the consequences. Anthracyclines cause cardiomyopathy. Mediastinal radiotherapy causes coronary and valve disease, and, twenty to thirty years later, breast and lung cancer inside the irradiated field; the lung cancer risk multiplies with smoking rather than adding to it. Neck radiotherapy causes hypothyroidism in a large minority. Procarbazine and other alkylators cause infertility and a small excess of myelodysplasia and leukaemia. Bleomycin causes lung fibrosis.\n\nThe long-term German Hodgkin Study Group series of 471 patients with the nodular lymphocyte-predominant subtype makes the arithmetic plain: ten-year overall survival was 92.1 per cent, second cancers occurred in 10.2 per cent, and of 43 deaths only 10 were from the lymphoma, against 20 from second cancers and 13 from conditions possibly related to treatment.\n\nFollow-up therefore includes cardiovascular risk assessment, thyroid function after neck or upper mediastinal radiotherapy, echocardiography at intervals, active smoking cessation support, and, in England, automatic referral into the NHS breast screening programme's very high risk pathway for women who had radiotherapy to breast tissue for Hodgkin or non-Hodgkin lymphoma between the ages of 10 and under 36. All of it is the reason treatment keeps being de-escalated.","refs":["lymphoma-tx-hodgkin-late-effects","late-effects","secondary-malignancy","cardiotoxicity","survivorship-care-plan","strain-echocardiography-gls","paper-eichenauer-nlphl-ghsg-hd7-hd15-long-term-jco-2020"],"guideline":{"version":"NCCN Hodgkin Lymphoma survivorship; NCI PDQ","url":"https://www.cancer.gov/types/lymphoma/hp/adult-hodgkin-treatment-pdq"}}],"stateOfArt":["Immunotherapy in first line with less toxicity.","Nivolumab-AVD is the new frontline standard for advanced disease (S1826: 2-year PFS 92%, neuropathy halved), approved March 2026 for ages 12 and up.","Two intensive but de-toxified European options: PET-guided BrECADD (HD21) achieves ~94% 5-year PFS with 40% less morbidity than eBEACOPP.","Interim PET steers therapy for nearly every patient: bleomycin omission (RATHL), radiotherapy omission (HD16/17, RAPID), cycle number (HD18, HD21).","Radiotherapy is disappearing from advanced-stage care (<1% in S1826) and being minimised in early stage.","PD-1 blockade is the most effective single agent in any lymphoma relapse (ORR ~70%), and beat brentuximab head to head (KEYNOTE-204).","Cure rates above 90% in young patients shift the research agenda to late effects and to older adults.","The cancer cell is the minority. A classical Hodgkin lymph node is mostly T cells, eosinophils, plasma cells, macrophages and fibrosis; the Hodgkin and Reed-Sternberg cells are a small fraction of it, and their clonal B-cell identity had to be proved by picking single cells off a slide with a micromanipulator. This is why an excisional biopsy is usually needed and why bulk sequencing of a Hodgkin node measures the infiltrate rather than the tumour.","Checkpoint blockade works here for a genetic reason. The 9p24.1 amplicon carries CD274, PDCD1LG2 and JAK2, so one copy-number event raises both PD-1 ligands by gene dose and by transcription; 97% of 108 cases carried concordant alterations of the two ligand loci, with amplification in 36% and copy gain in 56%. PD-1 blockade gave an objective response in 20 of 23 heavily pre-treated patients. Nothing is tested first, because almost every case has the alteration.","What predicts a complete remission on a checkpoint inhibitor is MHC class II, not class I, on the Reed-Sternberg cells, which points at a CD4 T cell as the effector and makes CIITA rearrangement, present in 15% of cases, an escape route as well as a cause.","The infiltrate carries prognosis of its own: more CD68-positive macrophages meant shorter progression-free survival, more relapse after autologous transplant and shorter disease-specific survival in an independent cohort of 166 patients, outperforming the International Prognostic Score. It is not used to choose treatment; the interim PET scan is."],"history":[{"year":1832,"title":"Thomas Hodgkin describes the disease; Reed and Sternberg characterise the cell (1898-1902)","refs":["reed-sternberg-cell"]},{"year":1950,"title":"Peters shows extended-field radiotherapy can cure early-stage disease","refs":["imrt-igrt"]},{"year":1964,"title":"MOPP: first combination chemotherapy cure","refs":[]},{"year":1964,"title":"MOPP: the first combination chemotherapy to cure an advanced cancer (DeVita, NCI)","refs":["cytotoxic-chemotherapy"]},{"year":1975,"title":"ABVD introduced (Bonadonna); becomes global standard by the 1990s","refs":["doxorubicin"]},{"year":1992,"title":"Escalated BEACOPP developed by the German Hodgkin Study Group","refs":["gbg"]},{"year":2000,"title":"Autologous transplant standard for relapse; late-effects registries reveal cardiac and second-cancer burden","refs":["autologous-stem-cell-transplant","cardio-oncology"]},{"year":2003,"title":"The dose-response curve for breast cancer after Hodgkin radiotherapy","note":"Travis: 4 Gy or more to the breast carried a 3.2-fold risk and over 40 Gy an eightfold risk, with no plateau; ovarian damage from alkylating agents or radiation lowered the risk, showing that hormonal stimulation is needed for radiation-induced breast cancer.","refs":["paper-travis-breast-cancer-after-hodgkin-radiotherapy-jama-2003"]},{"year":2010,"title":"Two cycles and 20 Gy is enough for early favourable disease","note":"HD10 randomised 1,370 patients in a two by two design: five-year freedom from treatment failure 93.0 against 91.1 per cent for four against two cycles of ABVD (p = 0.39) and no difference between 30 Gy and 20 Gy (p = 1.00).","refs":["paper-ghsg-hd10-reduced-intensity-early-hodgkin-nejm-2010","hd10"]},{"year":2011,"title":"Brentuximab vedotin approved","refs":["brentuximab-vedotin"]},{"year":2011,"title":"Brentuximab vedotin approved for relapsed disease; CD30 validated as an ADC target","refs":["brentuximab-vedotin","cd30"]},{"year":2014,"title":"Lugano classification formalises PET staging and the Deauville scale","refs":["lugano-classification","deauville-score"]},{"year":2015,"title":"AETHERA: brentuximab consolidation after transplant","refs":["aethera"]},{"year":2015,"title":"What curing Hodgkin lymphoma costs forty years later","note":"Schaapveld: 48.5 per cent of 3,905 survivors developed a second cancer within 40 years, with risk still 3.9 times the population rate after 35 years and no fall between the 1965 to 1976 and 1989 to 2000 treatment periods. Van Nimwegen: 50 per cent developed cardiovascular disease within 40 years.","refs":["paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015","paper-van-nimwegen-cardiovascular-disease-after-hodgkin-jama-intern-med-2015","lymphoma-ev-late-effects-of-the-treatments-given-now"]},{"year":2016,"title":"RATHL: bleomycin dropped after negative interim PET; nivolumab approved for relapse (CheckMate 205)","refs":["rathl","checkmate-205","nivolumab"]},{"year":2017,"title":"The interim scan directs intensification better than it directs de-escalation","note":"EORTC H10 raised five-year progression-free survival in scan-positive early-stage patients from 77.4 to 90.6 per cent by switching to escalated BEACOPP, but could not demonstrate non-inferiority of dropping radiotherapy after a negative scan in either risk group. HD18 shortened escalated BEACOPP to four cycles after a negative scan with five-year progression-free survival of 92.2 against 90.8 per cent and half the severe infections.","refs":["paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017","paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017","eortc-h10","hd18"]},{"year":2018,"title":"ECHELON-1: BV-AVD approved frontline; radiotherapy omission trials (RAPID, HD16/17) report","refs":["echelon-1","pet-adapted-therapy"]},{"year":2019,"title":"Omitting radiotherapy costs 7.3 points, and switching to ABVD costs nothing","note":"HD16: five-year progression-free survival 86.1 per cent without radiotherapy against 93.4 per cent with it after a negative scan. AHL2011: switching scan-negative patients from escalated BEACOPP to ABVD gave 85.7 against 86.2 per cent with grade 3 to 4 anaemia falling from 69 to 28 per cent.","refs":["paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019","paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019","hd16","ahl2011"]},{"year":2020,"title":"KEYNOTE-204: pembrolizumab beats brentuximab in relapse","refs":["keynote-204","pembrolizumab"]},{"year":2022,"title":"ECHELON-1 shows overall survival benefit; WHO reclassifies nodular lymphocyte-predominant disease","refs":["echelon-1"]},{"year":2023,"title":"SWOG S1826: nivolumab-AVD beats BV-AVD (ASCO plenary)","refs":["swog-s1826"]},{"year":2024,"title":"HD21 (BrECADD) published in Lancet; S1826 in NEJM","refs":["hd21","swog-s1826"]},{"year":2026,"title":"Nivolumab-AVD approved first line","refs":["nivolumab"]},{"year":2026,"title":"Nivolumab-AVD approved by FDA (20 March) for ages 12+; HD21 5-year data confirm BrECADD","refs":["swog-s1826","nivolumab","hd21"]},{"year":2030,"title":"RADAR reports","note":"RADAR (NCT04685616, 1,042 estimated participants) replaces bleomycin with brentuximab vedotin and omits radiotherapy entirely after a Deauville score of 1 to 3; the registry lists primary completion for September 2030.","refs":["radar-hodgkin","lymphoma-ev-radiotherapy-free-early-hodgkin"]}],"pipeline":["abexinostat","mk-1045","cobolimab","rondecabtagene-autoleucel","krt-232","azd3470","englumafusp-alfa","azd4512","jnj-90014496","ctx112","at101","men1703","cd19-t-hank","ahod2131","idea-chemo-free-hodgkin","idea-cd30-car-t-hodgkin","ctdna-lymphoma-monitoring","pet-adapted-therapy","cd30","hd21"],"openProblems":["Late toxicity in survivors.","Older patients.","Late effects dominate: cardiac disease, breast and lung cancer after mediastinal radiotherapy, infertility; survivors need lifelong surveillance that most health systems do not organise.","Older patients (>60) have roughly half the cure rate and double the toxicity; the best regimen for them is unsettled.","The ~10-15% with primary refractory or early-relapsing disease still need transplant; those failing PD-1 blockade have few options beyond allogeneic transplant.","Interim PET has limited positive predictive value; ctDNA-guided designs are unproven.","Access: brentuximab and nivolumab are costly and unavailable in many countries where EBV-positive Hodgkin lymphoma is common in children.","Nodular lymphocyte-predominant disease is now a separate entity with little trial evidence of its own.","Radiotherapy omission trades a few percent of PFS for lower late toxicity; the right trade-off differs by age and sex.","Three countries now have three different standards for the same advanced-stage disease: nivolumab with AVD in the United States after SWOG S1826, PET-guided BrECADD in Germany after HD21, and PET-adapted ABVD or brentuximab-AVD in much of the United Kingdom. They have never been compared with each other, and none has overall survival data at the timescale on which this disease is measured.","The consequences of PD-1 blockade given to a 20-year-old who will live another sixty years are unknown, and the trials that made it a first-line standard have a few years of follow-up in a disease whose main late harms appear after twenty.","Omitting radiotherapy in PET-negative early-stage disease costs several percentage points of disease control in both HD16 and RAPID and costs nothing in survival, and there is no way to tell an individual patient whether they are one of the people it would have saved a relapse.","Older patients tolerate every intensive Hodgkin regimen poorly and are excluded from most trials, so the commonest treatment failure in this disease happens in the group with the least evidence.","Every attempt to omit radiotherapy from early-stage Hodgkin lymphoma on the strength of a negative interim scan has cost tumour control: 7.3 percentage points in HD16 and a failure to demonstrate non-inferiority in either risk group of EORTC H10.","The late-effect figures that justify de-escalation come from patients treated up to 2000 with mantle fields. Nobody knows the forty-year risks of involved-site radiotherapy, brentuximab vedotin, checkpoint inhibitors or CAR-T, and the field is making decisions on a harm estimate drawn from a treatment that is no longer given."]},"route":"/cancers/hodgkin-lymphoma/","neighbours":{"pairing":[{"id":"bleomycin-omission-caution","kind":"pairing","name":"Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF","route":"/pairings/bleomycin-omission-caution/"},{"id":"doxorubicin-cardio-caution","kind":"pairing","name":"Caution: cumulative anthracycline dose and the heart","route":"/pairings/doxorubicin-cardio-caution/"},{"id":"pd1-plus-avd-hodgkin","kind":"pairing","name":"PD-1 blockade + AVD chemotherapy","route":"/pairings/pd1-plus-avd-hodgkin/"}],"biomarker":[{"id":"pd-ligand-9p24-alteration","kind":"biomarker","name":"9p24.1 alteration of the PD-1 ligand loci","route":"/biomarkers/pd-ligand-9p24-alteration/"},{"id":"cd30-expression","kind":"biomarker","name":"CD30 expression 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