• Escalated chemotherapy or ABVD in advanced Hodgkin lymphoma: more cures, more late harm, and what the interim scan changed: Advanced Hodgkin lymphoma can be treated with a gentler combination that fewer people are cured by first time, or a harder one that cures more but leaves more lasting harm.
• ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens): The chemotherapy recipes that cure most Hodgkin lymphoma: ABVD (four drugs, the long-standing standard), the more intensive German BEACOPP, and newer versions that replace bleomycin with brentuximab vedotin (A+AVD) or add nivolumab (N-AVD).
• Reed-Sternberg cell: The Reed-Sternberg cell is the giant, often two-nucleus cancer cell of Hodgkin lymphoma; it makes up only about 1% of the tumour, and the rest is immune cells it has recruited.
• After Hodgkin lymphoma: the late effects, and the screening that follows them: Most people treated for Hodgkin lymphoma are cured, and the long follow-up cohorts show that the treatment leaves a raised risk of heart disease, of a second cancer and of an underactive thyroid for decades.
• Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them: Hodgkin lymphoma is usually cured, and the problems that follow arrive twenty and thirty years later: heart disease, an underactive thyroid, and second cancers, especially breast cancer in women irradiated to the chest when young.
• Cardiotoxicity (LVEF decline, cardiomyopathy): Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm.
• British and American lymphoma practice: where they differ, and why: The same trials are read in both countries and reach different conclusions, because the British system asks what a treatment costs for the benefit it gives and the American one asks whether it is better at all.
• Deauville five-point scale: A 1-to-5 score for how bright a lymphoma looks on PET compared with the liver; 1-3 is considered a complete metabolic response.
• Fertility before lymphoma treatment: what to ask for, and when: Several lymphoma treatments can end fertility, and the chance to preserve it exists only before the first dose.
• Fertility preservation before lymphoma treatment: a decision with a deadline in days: Most of the ways of preserving fertility have to happen before the first dose of chemotherapy, and two of them take about a fortnight.

Staging and risk: FDG-PET/CT with Lugano staging, International Prognostic Score, fertility counselling and cardiac and pulmonary baselines.

Biomarker results to ask for: International Prognostic Score (IPS 0 to 7), Interim FDG-PET after cycle two (Deauville score, RATHL and HD18 escalation or de-escalation), Baseline metabolic tumour volume, CD30 expression (universal; brentuximab target), 9p24.1 amplification and PD-L1 expression (PD-1 responsiveness), Circulating tumour DNA (research).

Scans and tests linked to this cancer: FDG PET, Multidisciplinary tumour boards, PET-adapted (response-adapted) therapy, PET/CT, ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Children: Response-adapted Children's Oncology Group or EuroNet regimens; brentuximab vedotin with AVD in advanced paediatric disease; radiotherapy for slow responders only. (A Study of Brentuximab Vedotin + Adriamycin, Vinblastine, and Dacarbazine in Pediatric Participants With Advanced Stage Newly Diagnosed Hodgkin Lymphoma, Brentuximab vedotin, Children's Oncology Group (COG), PET-adapted (response-adapted) therapy)
• First line, adults and adolescents 12 and over: Nivolumab with AVD for six cycles (SWOG S1826, preferred); brentuximab vedotin with AVD (ECHELON-1) as an alternative; PET-adapted ABVD with bleomycin omission after two cycles (RATHL) where antibodies are unavailable. (Nivolumab, SWOG S1826, Brentuximab vedotin, ECHELON-1, Doxorubicin, Vinblastine, Dacarbazine, RATHL, PD-1 blockade + AVD chemotherapy, Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF)
• First line, intensive European option: BrECADD for four to six cycles guided by interim PET (GHSG HD21), replacing escalated BEACOPP. (GHSG HD21, Brentuximab vedotin, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), PET-adapted (response-adapted) therapy)
• Older or frail patients: AVD with brentuximab vedotin sequenced before and after, or nivolumab-AVD; avoid bleomycin and BEACOPP. (Brentuximab vedotin, Nivolumab, Doxorubicin, Cardio-oncology)
• End of treatment: PET-directed consolidation radiotherapy only for residual PET-positive bulky disease; long-term survivorship follow-up. (FDG PET, IMRT / IGRT (modern external beam), Deauville five-point scale, Late effects and survivorship toxicity)
• Advanced Hodgkin lymphoma in the United States: nivolumab with AVD: SWOG S1826 randomised 994 patients aged 12 and over with untreated stage III or IV classical Hodgkin lymphoma to nivolumab with AVD or to brentuximab vedotin with AVD, the regimen that had itself displaced ABVD. Two-year progression-free survival was 92 against 83 per cent (hazard ratio 0.45), and any-grade peripheral neuropathy was 28.1 against 54.2 per cent. It is the first trial in this disease to include adolescents and adults in a single protocol, and the FDA approved nivolumab with doxorubicin, vinblastine and dacarbazine for previously untreated stage III or IV classical Hodgkin lymphoma in adults and children of 12 and over on 20 March 2026, converting the two earlier relapsed-disease accelerated approvals to traditional approval at the same time. It is a genuinely gentler regimen as well as a more effective one: less neuropathy, less growth-factor requirement, and no bleomycin. The subset analysis of the 99 eligible patients aged 60 and over reported two-year progression-free survival of 89 per cent with nivolumab-AVD against 64 per cent with brentuximab-AVD (hazard ratio 0.24) and two-year overall survival of 96 against 85 per cent (hazard ratio 0.16), with non-relapse mortality of 6 against 16 per cent, 55 per cent discontinuing brentuximab vedotin against 14 per cent discontinuing nivolumab, and six cycles delivered without dose reduction in 69 against 26 per cent. That matters, because older patients tolerate brentuximab-AVD badly and are the group in which first-line treatment most often fails. What is not yet known: overall survival has not separated, follow-up is short for a disease measured in decades, and the long-term consequences of PD-1 blockade in a 20-year-old who will live another 60 years are unknown. That last point is the honest counter-argument to adopting it everywhere. (SWOG S1826, Nivolumab, Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), British and American lymphoma practice: where they differ, and why, SWOG S1826: nivolumab plus AVD chemotherapy versus brentuximab-AVD for advanced Hodgkin lymphoma in adolescents and adults)
• Advanced Hodgkin lymphoma in Germany and much of Europe: PET-guided BrECADD: GHSG HD21 randomised about 1,500 patients aged 18 to 60 with untreated advanced-stage classical Hodgkin lymphoma to PET-guided BrECADD or PET-guided escalated BEACOPP. Four-year progression-free survival was 94.3 against 90.9 per cent (hazard ratio 0.66) and treatment-related morbidity, a composite of organ toxicity, infection and haematological toxicity, was 42 against 59 per cent. BrECADD replaces the bleomycin, vincristine and procarbazine of escalated BEACOPP with brentuximab vedotin and dacarbazine, which removes the lung toxicity, most of the neuropathy and much of the infertility risk, and PET guidance means most patients receive four cycles rather than six. This is the highest progression-free survival reported in advanced Hodgkin lymphoma. It is also intensive treatment that requires an experienced unit, hospital admission for febrile neutropenia in a substantial minority, and growth-factor support throughout. The earlier PET-guided BEACOPP trials, HD18 and AHL2011, established the principle: HD18 reduced treatment from eight cycles to four in PET-negative patients, and AHL2011 switched PET-negative patients from escalated BEACOPP to ABVD, in both cases without losing disease control. (GHSG HD21, Brentuximab vedotin, Etoposide, Cyclophosphamide, Doxorubicin, Dacarbazine, Dexamethasone, Procarbazine, Bleomycin, Vincristine, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), FDG PET, PET-adapted (response-adapted) therapy, Fertility before lymphoma treatment: what to ask for, and when, GHSG HD21: PET-guided BrECADD versus escalated BEACOPP in advanced-stage classical Hodgkin lymphoma)
• Advanced Hodgkin lymphoma with ABVD and brentuximab: what the earlier standards showed: The two regimens that the current standards displaced are still used, and still reasonable where the newer ones are not available. ABVD with PET adaptation. RATHL enrolled 1,214 patients and showed that in those whose PET after two cycles was negative, bleomycin could be omitted from cycles 3 to 6 without loss of control: three-year progression-free survival 85.7 per cent for continued ABVD against 84.4 per cent for AVD, with less lung toxicity. This remains common British practice and is a perfectly defensible treatment. Brentuximab vedotin with AVD. ECHELON-1 randomised 1,334 patients with untreated stage III or IV disease to A+AVD or ABVD: two-year modified progression-free survival was 82.1 against 77.2 per cent (hazard ratio 0.77) and, at six years, overall survival was 93.9 against 89.4 per cent (hazard ratio 0.59). It is the only first-line trial in advanced Hodgkin lymphoma to show an overall survival advantage. The cost is peripheral neuropathy, which is commoner and more severe than with ABVD; in SWOG S1826 any-grade peripheral neuropathy was 54.2 per cent with brentuximab-AVD against 28.1 per cent with nivolumab-AVD. Growth-factor support is mandatory. In England, NICE TA1059 recommends brentuximab vedotin with doxorubicin, dacarbazine and vinblastine for untreated stage 3 or 4 CD30-positive Hodgkin lymphoma in adults, so this is the regimen that is funded first line; there is no NICE appraisal of nivolumab with AVD. Older and frail patients tolerate none of these well. Options are ABVD with bleomycin omitted, sequential brentuximab vedotin before and after AVD, or a reduced-intensity regimen, and the choice is made on comorbidity rather than on chronological age. (RATHL, ECHELON-1, Brentuximab vedotin, Doxorubicin, Bleomycin, Vinblastine, Dacarbazine, Growth factors: G-CSF and febrile neutropenia prevention, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma, ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.