First-line treatment of advanced-stage Hodgkin lymphoma

Guideline Objective

• To decide what is the preferred first-line treatment strategy for patients with advanced-stage HL among ABVD, brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (B-AVD), A-AVD, eBEACOPP, and other treatments with or without PET response-adapted strategies.
• To determine the role of radiation as part of the first-line time treatment strategy for these patients.

Patient Population

Adult patients (≥18 years of age) with advanced-stage HL that require upfront (first-line) treatment. Question 1 focuses on patients aged ≥18 and up to 60 years of age; Question 2 focuses on patients aged 60 and over, and Question 3 focuses on all adult patients.

Intended Guideline Users

Clinicians treating patients with advanced-stage HL that require first-line treatment, including hematologists, radiation oncologists, radiologists, medical oncologists, nurse practitioners and hematology pharmacists.

Research Questions

1. For patients younger than 60 years of age, what is the ideal treatment strategy, among A-AVD, ABVD, ABVD-PET adapted, eBEACOPP, and eBEACOPP–PET adapted, as part of the first-line therapy, to improve patient outcomes, and how does it affect adverse events (AE)?
2. For patients 60 years of age and older what is the ideal treatment strategy, among ABVD, B-AVD, brentuximab alone or in combination, PVAG (prednisone, vinblastine, doxorubicin, gemcitabine), CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone), CHLVPP (Chlorambucil-VinBLAStine-Procarbazine-Prednisone), or other agents, as part of the first-line therapy to improve patient outcomes, and how does it affect AE?
3. Does consolidation radiotherapy after first-line chemotherapy improve outcomes such as overall survival (OS), progression-free survival (PFS), recurrence, adverse events (AE), and quality of life (QoL) in adult patients with advanced-stage HL?