Novel agents now enable “excellent” outcomes in Hodgkin lymphoma and play a central role in upcoming guidelines, delegates at the European Haematology Association (EHA) Congress heard.
The latest EHA guidelines recommend regimens with brentuximab vedotin and nivolumab as treatment options in advanced-stage classic Hodgkin lymphoma.
Immune checkpoint inhibitors are also included as second-line options for relapsed and refractory disease.
“With a checkpoint inhibitor-containing salvage therapy, complete metabolic response of up to 90% can be achieved, and given this, when patients proceed to high-dose chemotherapy, outcomes are excellent,” Dr Dennis Eichenauer of the University of Cologne, Germany, told delegates.
In his presentation, Dr Eichenauer said that the guidelines had been accepted for publication and gave a brief overview of the changes to recommendations on the management of early-stage, advanced-stage and relapsed disease.
The guidelines were developed by an interdisciplinary group of 18 experts, including 12 haemato-oncologists, as well as radiotherapists/radiation oncologists, a nuclear medicine specialist, a pathologist, and a patient representative.
In patients with early-stage favourable classic Hodgkin lymphoma, standard treatment remains the same as the previous guideline: two cycles of ABVD chemotherapy followed by 20 Gy radiotherapy.
Dr Eichenauer highlighted that trials have consistently shown that omitting consolidation radiotherapy leads to loss of disease control.
“A chemotherapy-alone approach in early-stage classic Hodgkin lymphoma should therefore be restricted to patients with strong arguments against the use of consolidation radiotherapy,” he said.
For younger patients with early-stage unfavourable classic Hodgkin lymphoma, the guidelines now recommend two cycles of escalated BEACOPP, or an escalated BEACOPP variant, such as BEACOPDac, followed by two cycles of ABVD and consolidation radiotherapy, although the latter can be omitted if patients have a negative PET result.
For patients with early-stage unfavourable disease who are older than 60 years, or who refuse or are not eligible for escalated BEACOPP-based treatment, the guidelines recommend four cycles of ABVD or AVD followed by 30 Gy limited-field radiotherapy.
In patients with advanced-stage classic Hodgkin lymphoma, the guidelines instead recommend PET2-guided BrECADD followed by radiotherapy to PET-positive residual lymphoma, which has shown improved progression-free survival (PFS) and less toxicity compared to escalated BEACOPP.
In older patients, and as an option in younger patients, six cycles of nivolumab combined with AVD chemotherapy followed by PET-guided radiotherapy is recommended, with trial data showing improved PFS from nivolumab and AVD over brentuximab vedotin and AVD.
For patients with relapsed or refractory classic Hodgkin lymphoma, the guidelines now recommend high-dose chemotherapy and autologous stem cell transplantation, then an immune checkpoint inhibitor-based salvage treatment followed by consolidation high-dose chemotherapy and autologous stem cell transplantation.
Dr Eichenauer highlighted data showing that in “patients who responded to pembro-GVD and then proceeded to high-dose chemotherapy and autologous stem cell transplantation, there were no cases of disease recurrence after a median follow-up of 14 months.”