Treatment of Patients with Local Stages of Newly Diagnosed Classical Hodgkin Lymphoma: A Literature Review, Current Approaches, and Our Own Experience

Abstract

Aim. To determine an optimal amount of program therapy for patients with local (I/II) stages of newly diagnosed classical Hodgkin lymphoma (cHL) who are stratified into prognostic groups by different risk factors (RF).
 Materials & Methods. The present study is based on the clinical data from 125 patients with local (I/II) stages of newly diagnosed cHL. All of them were treated at the NN Blokhin National Medical Cancer Research Center from 2000 to 2022. The patients were aged 18–67 years (median 29 years), most of them were women (n = 90; 72 %). The patients were stratified into 3 prognostic groups with respect to the following RFs: В-symptoms, ESR level, bulky mediastinum, lesion number, and stage E. Group 1 regarded as prognostically favorable (stages I/IIA without RFs) included 22 (18 %) patients; group 2 with intermediate prognosis (stages I/IIA–В, ≥ 3 lesions and/or ESR ≥ 30 mm/h with B-symptoms or ESR ≥ 50 mm/h without them) consisted of 45 (36 %) patients; group 3 regarded as prognostically unfavorable (stages I/IIА, bulky mediastinum and/or extranodal lesions, i.e. stage Е) included 58 (46 %) patients. In group 1, there were no patients with B-symptoms. In group 3, patients with intoxication symptoms were excluded from the analysis. Chemotherapy programs in prognostic groups (risk groups) differed: 2–4 ABVD cycles in group 1 and 6 EACOPP-14 cycles in group 3. Both regimens were used in group 2. This was the category of patients with intermediate prognosis which required modifications in the drug therapy program due to the interim PET2 results and continued in the form of de-escalated treatment: 2 ЕАСОРР-14 cycles → PET2-negative status → 2 AVD cycles (n = 20). This model proved to be most effective by the present study and did not exclude the applicability of the programs either with 4 cycles of ЕАСОРР-14 alone (n = 12) or 4–6 cycles of ABVD alone (n = 13) in the group of intermediate prognosis. After completing the drug therapy phase, radiotherapy was performed in 113 (91 %) patients.
 Results. The median follow-up was 46 months. Taken as a whole, the treatment showed high efficacy: the 5-year progression-free survival appeared to be 93 %, and the 5-year overall survival was 99 %.
 Conclusion. The stratification of patients into 3 prognostic groups (favorable, intermediate, and unfavorable) provides the basis for determining a drug chemotherapy program which would be optimal in its amount, efficacy, and toxicity profile for patients with local stages of newly diagnosed cHL. Further study of escalation and de-escalation strategies in the program chemotherapy for patients with stages I/IIA of newly diagnosed cHL having or not having a bulky tumor mass in mediastinum, based on PET2 results, can help to improve, first of all, the quality of life of patients as well as short- and long-term chemotherapy outcomes in general. In this context, chemotherapy escalation is possible in the cases of PET2-positive status, whereas its de-escalation would be considered in the cases of PET2-negative status.