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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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.
That 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.
| Setting | Approach | Guideline |
|---|---|---|
| Advanced stage | Nivolumab-AVD (2026) or BV-AVD; PET-adapted. | not mapped |
| Early stage, favourable (I-II) | 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. | NCCN Category 1 (ABVD × 2 + ISRT 20 Gy or PET-adapted chemotherapy alone) |
| Early stage, unfavourable (I-II bulky or risk factors) | ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials. | NCCN Category 2A |
| Advanced stage (III-IV), age ≤60 | 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. | NCCN Category 1 (nivolumab-AVD preferred; BV-AVD), ESMO-MCBS A (ECHELON-1) |
| Advanced stage, age >60 | Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation. | not mapped |
| First relapse, transplant-eligible | 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. | NCCN Category 1 (ASCT after chemosensitive salvage; BV consolidation for high risk) |
| Relapse after transplant or transplant-ineligible | 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. | NCCN Category 1 (pembrolizumab, nivolumab, brentuximab) |
| Paediatric (COG / EuroNet) | 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. | not mapped |