Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a highly treatable cancer, with current treatments curing 80-90% of newly diagnosed patients. The presence of Hodgkin Reed-Sternberg (HRS) cells characterizes classical Hodgkin lymphoma (cHL). Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a distinct clinicopathological entity from cHL. Treatment options for patients with primary cHL is determined by stage, bulk and contemporaneous factors including age, pregnancy and HIV. Positron emission tomography/computed tomography (PET/CT) is recommended in diagnosis, staging and remission assessment. Standard treatments for cHL include chemotherapy and in some cases radiotherapy (RT). The use of early interim PET/CT scans to escalate or de-escalate treatment has been the subject of investigation with the goal of maximizing efficacy and minimizing toxicity. Unlike cHL, there is no consensus on the definitive treatment of NLPHL. Relapsed cHL patients are usually treated with autologous stem cell transplant (ASCT), although heterogeneity exists with respect to pre-transplant salvage therapy, ASCT preparative regimen and the use of RT. Current therapies cure approximately 50% of patients with relapsed and/or refractory cHL, novel agents including brentuximab vendotin and PD-1 inhibitors are being trialed in the unresponsive patient population. With 10% to 15% of newly diagnosed HL patients aged less than 20 years and nearly one third in the 20- to 34-year age range, minimizing serious late effects is critical when measuring the success of HL treatments. Similarly, selection of patients who would benefit from more intensive or novel first-line approaches, as well as those who would benefit from less therapy is an ongoing challenge.