NORDIC LYMPHOMA GROUP GUIDELINES 2000

HODGKIN’S LYMPHOMA

Working group for Hodgkin’s lymphoma, Nordic Lymphoma Group:
Gunilla Enblad, Uppsala
Lena Specht, København
Taina Turpenniemi-Hujanen, Oulu
Ole Nome, Oslo

April 2000

LP Histology
Most of these patients have early stage disease. They are treated according to a separate protocol with radiotherapy alone or proceeded by 2 – 4 chemotherapy courses according to risk factors (see protocol).

If advanced stage disease, they are treated as classical HD.

Classical HD histology
Early and intermediate stages (I – IIA)
See separate protocol.

Advanced stages (IIB – IV) < 60 years.

The recommended reference regimen is ABVD for eight courses. Six courses can be given if the tumours respond early (CR after two or at the most four courses). Involved field RT (30 Gy) is recommended if the disease was initially bulky, if the tumour responds slowly (no CR until after eight courses) or if no CR is reached.

Comments: BEACOPP (baseline or escalated) has in the German HD study shown improved disease-free survival vs CHOPP/ABVD but no definite survival benefit. This results are undisputable, but not solid enough to recommend BEACOPP as reference treatment for any patient except those that may show an unusually aggressive clinical picture. BEACOPP means increased both acute and late toxicity, and thus unnecessary toxicity to a substantial proportion of the patients (> 50% even in the highest IPI-group and 70 – 90 % of those with few risk factors). A strategy with ABVD for all patients with planned salvage therapy for those failing ABVD is the recommended approach by virtually all Nordic centres. However, it is intriguing that BEACOPP as initial treatment may be superior to ABVD as initial treatment. Therefore, discussions are ongoing with EORTC and GELA about the joint study. Most likely, most Nordic centres will join a study where high risk patients (IPI 3+) are randomised between 6 – 8 ABVD and 4 escalated BEACOPP followed by 2 – 4 baseline BEACOPP. Consolidating IF RT will be given for initially bulky disease.

ABVD gave in one US study fewer secondary malignancies