Opinion statement
Four of five patients with Hodgkin’s disease (HD) will be cured with modern treatment strategies, depending on stage and risk factor profile. In early stage favorable HD, cure rates are greater than 90% with extended field (EF) irradiation, the standard treatment. However, the concept of EF irradiation therapy is being abandoned by most study groups because of the recognition of fatal long-term effects, especially the high rates of second solid tumors. Newer approaches include mild chemotherapy combined with involved field (IF) irradiation to control occult disease. Combined modality is the treatment of choice in early stages unfavorable (intermediate) HD, in which EF irradiation is substituted by IF irradiation. In the last three decades, because of the high relapse rates (30%–50%) after first-line polychemotherapy, the standard regimens were often modified. However, until recently, these efforts could not change the relatively poor outcome for patients with advanced stage disease. The introduction of a new dose-intensified regimen (BEACOPP) has significantly improved the prognosis for patients with advanced HD. Patients who relapse after radiation therapy alone for early stage HD have satisfactory results with combination chemotherapy and are not considered as candidates for high-dose chemotherapy with autologous stem cell transplantation. For patients with relapsed HD after combination chemotherapy, the data support the use of high-dose chemotherapy with autologous stem cell transplantation.
Similar content being viewed by others
References and Recommended Reading
Carde P, Burger JM, Henry-Amar M: Clinical stages I and II Hodgkin’s disease: a specifically tailored therapy according to prognostic factors. J Clin Oncol 1988, 6:239–248.
Loeffler M, Pfreundschuh M, Rühl U: Risk factor adapted treatment of Hodgkin’s lymphoma: strategies and perspectives. Recent Results Cancer Res 1989, 117:142–162.
Hasenclever D, Diehl V: A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998, 339:1506–1514.
Sarris A, Kliche K, Pethambaram P, et al.: Interleukin-10 levels are often elevated in serum of adults with Hodgkin’s disease and are associated with inferior failure-free survival. Ann Oncol 1999, 10:433–439.
von Wasielewski R, Seth S, Franklin J, et al.: Tissue eosinophilia correlates strongly with poor prognosis in nodular sclerosing Hodgkin’s disease allowing for known prognostic factors. Blood 2000, 95: 1207–1213.
Duhmke E, Franklin J, Pfreundschuh M, et al.: Low-dose radiation is sufficient for the noninvolved extendedfield treatment in favorable early-stage Hodgkin’s disease: long-term results of a randomized trial of radiotherapy alone. J Clin Oncol 2001 19:2905–2914.
Carde P, Noordijk E, Hagenbeek A: Superiority of EBVP chemotherapy in combination with involved field irradiation over subtotal nodal irradiation in favorable clinical stage I-II Hodgkin’s disease: the EORTC-GPMC H7F randomized trial. Proc Am Soc Clin Oncol 1997, 16:13.
Diehl V, Sieber M, Rüffer U: Treatment of early-stage Hodgkin’s disease: considerations in the use of chemotherapy. Annual Meeting of American Society of Clinical Oncology, Los Angeles, CA, 1998.
Engert A, Schiller P, Pfistner B, et al.: Involved field (IF) radiotherapy is as effective as extended field (EF) radiotherapy after 2 cycles of COPP/ABVD in patients (pts) with intermediate-stage Hodgkin’s disease (HD): randomized multicenter study. Blood 2001, 98:3199a.
De Vita VT Jr, Simon RM, Hubbard G, et al.: Curability of advanced Hodgkin’s disease with chemotherapy: longterm follow-up of MOPP-treated patients at the National Cancer Institute. Ann Intern Med 1980, 92:587–595.
Bonadonna G, Zucali R, Monfardini S, et al.: Combination chemotherapy of Hodgkin’s disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer 1975, 36:252–260.
Canellos GP, Anderson JR, Propert KJ, et al.: Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992, 327:1478–1485.
Connors JM, Klimo P, Adams G, et al.: Treatment of advanced Hodgkin’s disease with chemotherapy— comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group. J Clin Oncol 1997, 15:1638–1645.
Sieber M, Rueffer U, Tesch H: Rapidly alternating COPP+ABV+IMEP CAI is equally effective as alternating COPP+ABVD CA for Hodgkin’s disease: final results of two randomised trials for intermediate HD5 protocol) and advanced HD6 protocol stages.tLeuk Lymphoma 1998, 29:93.
Carde P, MacKintosh F, Rosenberg S, et al.: A dose and time response analysis of the treatment of Hodgkin’s disease with MOPP chemotherapy. J Clin Oncol 1983, 1:146–153.
Bartlett N, Rosenberg S, Hoppe R, et al.: Brief chemotherapy, Stanford V, and adjuvant radiotherapy for bulky or advanced-stage Hodgkin’s disease: a preliminary report. J Clin Oncol 1995, 13:1080–1088.
Diehl V, Franklin J, Hasenclever D, et al.: BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin’s lymphoma: interim report from a trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 1998, 16:3810–3819.
Diehl V, Franklin J, Paulus U, et al.: BEACOPP chemotherapy with dose escalation in advanced Hodgkin’s disease: final analysis of the German Hodgkin Lymphoma Study Group HD9 randomized trial. Blood 2001, 98:3202a.
Loeffler M, Brosteanu O, Hasenclever D, et al.: Metaanalysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. International Database on Hodgkin’s Disease Overview Study Group. J Clin Oncol 1998, 16:818–829.
Cannellos G, Young RC, De Vita VD: Combination chemotherapy for advanced Hodgkin’s disease in relapse following extensive radiotherapy. Clin Pharmacol Ther 1972, 13:750–758.
Santoro A, Viviani S, Villarreal C, et al.: Salvage chemotherapy in Hodgkin’s disease irradiation failures: superiority of doxorubicin-containing regimens over MOPP. Cancer Treat Rep 1986, 70:343–351.
Longo D, Duffey P, Young R, et al.: Conventionaldose salvage combination chemotherapy in patients relapsing with Hodgkin’s disease after combination chemotherapy: the low probability for cure. J Clin Oncol 1992, 10:210–219.
Santoro A, Viviani S, Valagussa P, et al.: CCNU, etoposide, and prednimustine (CEP) in refractory Hodgkin’s disease. Semin Oncol 1986, 13:23–32.
Schulman P, McCarroll K, Cooper M, et al.: Phase II study of MOPLACE chemotherapy for patients with previously treated Hodgkin’s disease: a CALGB study. Med Pediatr Oncol 1990, 18:482–490.
Pfreundschuh M, Rueffer U, Lathan B, et al.: Dexa-BEAM in patients with Hodgkin’s disease refractory to multidrug chemotherapy regimens: a trial of the German Hodgkin’s Disease Study Group. J Clin Oncol 1994, 12:580–592.
Hagemeister F, Tannir N, McLaughlin P, et al.: MIME chemotherapy (methyl-GAG, ifosfamide, methotrexate, etoposide) as treatment for recurrent Hodgkin’s disease. J Clin Oncol 1987, 5:556–563.
Rodriguez J, Rodriguez M, Fayad L, et al.: ASHAP: a regimen for cytoreduction of refractory or recurrent Hodgkin’s disease. Blood 1999, 93:3632–3641.
Pfreundschuh MG, Schoppe WD, Fuchs R: Lomustine, etoposide, vindesine, and dexamethasone (CEVD) in Hodgkin’s disease refractory to cyclophosphamide, vincristine, procarbacine, and prednisone (COPP) and doxorubicine, bleomycin, vinblastine, and darcarbazine (ABVD): a multi-center trial of the German Hodgkin’s study group. Cancer Treat Rep 1987, 71:1203–1212.
Cowill R, Crump M, Couture F: Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin’s disease before intensive therapy and autologous bone marrow transplantation. J Clin Oncol 1995, 13:396–403.
Velasquez WS, Jagannath S, Hagemeister FB: Dexamethasone, high-dose ara-C and cisplatin as salvage treatment for relapsing Hodgkin’s disease. Proc Am Soc Hematol 1986, 68:242–249.
Josting A, Reiser M, Rueffer U, et al.: Treatment of primary progressive Hodgkin’s and aggressive non-Hodgkin’s lymphoma: is there a chance for cure? J Clin Oncol 2000, 18:332–339.
Sweetenham J, Taghipour G, Milligan D, et al.: High-dose therapy and autologous stem cell rescue for patients with Hodgkin’s disease in first relapse after chemotherapy: results from the EBMT. Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1997, 20:745–751.
Bierman P, Bagin R, Jagannath S, et al.: High dose chemotherapy followed by autologous hematopoietic rescue in Hodgkin’s disease: long-term follow-up in 128 patients. Ann Oncol 1993, 4:767–774.
Jones R, Piantadosi S, Mann R, et al.: High-dose cytotoxic therapy and bone marrow transplantation for relapsed Hodgkin’s disease. J Clin Oncol 1990, 8:527–534.
Josting A, Katay I, Rueffer U, et al.: Favorable outcome of patients with relapsed or refractory Hodgkin’s disease treated with high-dose chemotherapy and stem cell rescue at the time of maximal response to conventional salvage therapy (dexa-BEAM). Ann Oncol 1998, 9:289–295.
Linch D, Winfield D, Goldstone A, et al.: Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. Lancet 1993, 341:1051–1054.
Schmitz N, Sextro M, Pfistner B, et al.: HDR-1: high-dose therapy (HDT) followed by hematopoietic stem cell transplantation (HSCT) for relapsed chemosensitive Hodgkin’s disease (HD): final results of a randomized GHSG and EBMT trial (HD-R1). Proc ASCO 1999:18a.
Josting C, Rudolph M, Mapara Y, et al.: Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin’s and aggressive non-Hodgkin’s lymphoma: results of a multicenter phase-II study. Blood 2001, 98:2848a.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Glossmann, JP., Josting, A. & Diehl, V. New treatments for Hodgkin’s disease. Curr. Treat. Options in Oncol. 3, 283–290 (2002). https://doi.org/10.1007/s11864-002-0028-x
Issue Date:
DOI: https://doi.org/10.1007/s11864-002-0028-x