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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Oncology

Standard of Care and Frontline Treatments

At a Glance

Treatment for classic Hodgkin lymphoma uses response-adapted chemotherapy like ABVD or A+AVD. Doctors perform early PET scans to check tumor response. This allows them to safely adjust therapy in real-time to maximize the chances of a cure while minimizing long-term side effects.

The way doctors treat classic Hodgkin Lymphoma (cHL) has changed dramatically in recent years. Today, treatment is not “one size fits all.” Instead, it is response-adapted, meaning your medical team uses imaging to see how the cancer responds to the first few weeks of treatment and then adjusts the plan accordingly [1][2].

Treating Early-Stage Disease (Stage I-II)

For patients with early-stage disease, the goal is to achieve a cure while minimizing long-term side effects [3].

  • The Gold Standard: The most common chemotherapy is ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine) [4].
  • The “iPET” Decision: After two cycles of chemotherapy, you will have an interim PET (iPET) scan. If the scan is clear (iPET-negative), your doctor may decide to de-escalate your treatment. This could mean omitting the drug bleomycin (to protect your lungs) or potentially skipping radiation therapy entirely [4][5].
  • Involved-Site Radiation Therapy (ISRT): If radiation is needed, modern doctors use ISRT. Unlike older methods that radiated large areas, ISRT focuses only on the specific lymph nodes that were originally involved, which significantly reduces the risk of damage to nearby healthy organs like the heart and lungs [6][7].

Treating Advanced-Stage Disease (Stage III-IV)

For many years, ABVD was also the standard for advanced disease. However, a major clinical trial called ECHELON-1 changed the standard of care for many patients [8].

  • A+AVD (The New Standard): This regimen replaces bleomycin with brentuximab vedotin (a targeted antibody-drug conjugate), combining it with the remaining three drugs: Adriamycin, Vinblastine, and Dacarbazine (AVD). The trial showed that A+AVD is more effective than ABVD at preventing the cancer from returning and improves overall survival [9][10].
  • Trade-offs: While A+AVD removes the risk of lung toxicity from bleomycin, it does carry a higher risk of peripheral neuropathy (numbness or tingling in hands and feet) and low white blood cell counts (neutropenia) [11][12]. To manage this, patients on A+AVD typically receive “growth factor” (G-CSF) injections to boost their immune system [13].

Key Regimens at a Glance

Regimen Common Use Key Benefit Main Risk Consideration
ABVD Early & Advanced Stage Long track record of success Bleomycin can cause lung toxicity [4][14]
A+AVD Advanced Stage Higher cure & survival rates Risk of neuropathy & low white cells [9][12]
Escalated BEACOPP Advanced/High-Risk Extremely intensive & effective High toxicity; used as intensive frontline in some regions [15][16]

The Timeline and Day-to-Day Experience

When discussing treatment, doctors talk in cycles. A standard cycle of ABVD or A+AVD usually lasts 28 days, with intravenous (IV) infusions given on Day 1 and Day 15. The entire course often takes anywhere from 2 to 6 months, depending on your stage [4].

Day-to-day, you may experience fatigue, nausea (which is heavily managed with preventative medications given before your chemo), and hair loss. To make infusions and blood draws easier and to protect your veins, your team will likely recommend placing a port-a-cath (a small device under the skin on your chest) prior to starting treatment [13].

The Power of the Deauville Scale

To determine if your treatment is working, doctors use the Deauville 5-point scale to grade your PET scans [14]. A score of 1, 2, or 3 is generally considered “negative” (the treatment is working well), while a score of 4 or 5 may lead your doctor to intensify the treatment to ensure the cancer is fully eliminated [17][18]. This real-time adjustment is the key to the high success rates in treating cHL today [2].

Common questions in this guide

What does response-adapted therapy mean for classic Hodgkin lymphoma?
Response-adapted therapy means your medical team uses imaging, like PET scans, early in your treatment to see how the cancer is responding. Based on those results, they can safely adjust your treatment plan by either reducing it to prevent side effects or intensifying it to ensure the cancer is eliminated.
What is the difference between ABVD and A+AVD treatments?
ABVD is the long-standing gold standard chemotherapy combination for early and advanced stages. A+AVD is a newer regimen used for advanced stages that replaces the drug bleomycin with brentuximab vedotin, offering higher success rates but with a different side effect profile, including neuropathy.
Why do I need an iPET scan during treatment?
An interim PET scan, or iPET, is usually performed after two cycles of chemotherapy. It shows exactly how well your body is responding to the initial treatment, allowing your doctors to make a crucial decision about whether to change or continue your current chemotherapy regimen.
What does a Deauville score mean on my PET scan report?
The Deauville scale is a 5-point grading system used to read your PET scans. A score of 1, 2, or 3 means the treatment is working well and the scan is considered negative. A score of 4 or 5 means your doctor may need to intensify your treatment to fully eliminate the cancer.
Will I need growth factor shots with my chemotherapy?
If you receive the A+AVD regimen, you have a higher risk of developing low white blood cell counts, a condition called neutropenia. To keep your immune system safe and prevent infections, patients typically receive growth factor (G-CSF) injections alongside their chemotherapy.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Will my treatment plan be response-adapted, and if so, how will the results of my second-cycle PET scan (iPET2) specifically change my therapy?
  2. 2.Am I a candidate for the A+AVD regimen, and if so, what is the plan for managing potential side effects like peripheral neuropathy?
  3. 3.For early-stage disease, is my goal to avoid radiation therapy, or is combined modality therapy (chemo plus radiation) recommended for my specific case?
  4. 4.If I receive the A+AVD regimen, will I also receive 'growth factor' (G-CSF) shots to keep my white blood cell counts safe?
  5. 5.What is the Deauville score on my PET scan, and how does that number influence our next steps?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
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    Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence.

    Seshachalam A, Karpurmath SV, Rathnam K, et al.

    Journal of global oncology 2019; (5()):1-13 doi:10.1200/JGO.19.00179.

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    PET-adapted approaches to primary therapy for advanced Hodgkin lymphoma.

    Lang N, Crump M

    Therapeutic advances in hematology 2020; (11()):2040620720914490 doi:10.1177/2040620720914490.

    PMID: 32537115
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    Patterns of care and outcomes of early stage I-II Hodgkin lymphoma treated with or without radiation therapy.

    Weil CR, Parsons MJ, Hutten RJ, et al.

    Leukemia & lymphoma 2022; (63(12)):2847-2857 doi:10.1080/10428194.2022.2105325.

    PMID: 35904407
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    Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma.

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    The New England journal of medicine 2016; (374(25)):2419-29 doi:10.1056/NEJMoa1510093.

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    Relapse patterns in early-PET negative, limited-stage Hodgkin lymphoma (HL) after ABVD with or without radiotherapy-a joint analysis of EORTC/LYSA/FIL H10 and NCRI RAPID trials.

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    British journal of haematology 2023; (200(6)):731-739 doi:10.1111/bjh.18594.

    PMID: 36541117
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    Does Radiation Have a Role in Advanced Stage Hodgkin's or Non-Hodgkin Lymphoma?

    Specht L

    Current treatment options in oncology 2016; (17(1)):4 doi:10.1007/s11864-015-0377-x.

    PMID: 26739151
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    Proton therapy in mediastinal Hodgkin lymphoma: moving from dosimetric prediction to clinical evidence.

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    Update on the role of brentuximab vedotin in classical Hodgkin lymphoma.

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    PMID: 30210755
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    Real-World Patient Characteristics, Treatment Patterns, and Outcomes for Patients With Stage III or IV Classic Hodgkin Lymphoma Treated With Frontline ABVD: A Retrospective Database Review in the United States.

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    Clinical lymphoma, myeloma & leukemia 2023; (23(7)):527-534 doi:10.1016/j.clml.2023.03.015.

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    [Our experience with the treatment of Hodgkin lymphoma patients].

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    Older patients (aged ≥60 years) with previously untreated advanced-stage classical Hodgkin lymphoma: a detailed analysis from the phase III ECHELON-1 study.

    Evens AM, Connors JM, Younes A, et al.

    Haematologica 2022; (107(5)):1086-1094 doi:10.3324/haematol.2021.278438.

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    Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study.

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    Blood 2020; (135(10)):735-742 doi:10.1182/blood.2019003127.

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    Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management.

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    PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study.

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    Advanced Hodgkin's lymphoma: End-of-treatment FDG-PET should be maintained.

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This page provides educational information about standard frontline treatments for classic Hodgkin lymphoma. It is for informational purposes only and does not replace professional medical advice from your oncologist.

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