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Below, week by week, is what OnCo's record of Hodgkin lymphoma says about the first two months: the order is typical, the timing is yours to ask about. 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. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
Written by hand for this cancer from NHS, Macmillan, Cancer Research UK and charity pages, each item naming the page it came from. The days and weeks are the typical order those pages describe, not a schedule; tick what applies to you.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.
Nivolumab-AVD (2026) or BV-AVD; PET-adapted.
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.
Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.
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.
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. That 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). Before 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.
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.
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.
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.
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. The 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. Follow-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.
Written by hand for this cancer. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.