German Hodgkin Study Group

Nodular lymphocyte-predominant Hodgkin lymphoma is rarely fatal when treated with standard Hodgkin lymphoma protocols, so the goal for most patients is to give less treatment, not more; the minority with advanced or variant disease still need better options.

Radiotherapy cannot be omitted in early-stage favourable Hodgkin lymphoma on the basis of a negative interim scan without a clinically relevant loss of tumour control. The scan is better at identifying who needs more than at identifying who needs less.

The basis for four cycles of escalated BEACOPP as the German standard when the interim scan is negative, and the reason rituximab was abandoned as an addition to that regimen. The authors recommend the scan-guided strategy for all patients with advanced-stage disease.