Primary Treatment of HD
| Clinical Stage . | Primary Treatment . |
|---|---|
| I and II | |
| Very favorable | |
| Female; IA, IIA NSHD or ≤3 nodal sites and <26 yr Male; IA LPHD, neck or groin Age 11-60 yr ESR <50 No restrictions listed below | EF RT Consider: Mantle (IF) RT after negative lap; ABVD ×6 for smokers and females <27 |
| Favorable | |
| ≤3 nodal sites ESR <50 No restrictions listed below | EF RT after negative lap, or ABVD ×6 + RT to residual3-150disease, Consider: ABVD ×4 + mantle (IF) RT ABVD ×6 for smokers and females <27 |
| Unfavorable | |
| >3 nodal sites LMA or bulky (≥10 cm) adenopathy ESR >50 Fever and/or weight loss Bilateral hilar adenopathy Involvement of pericardium, pleura, lung or bone Gross lymphatic permeation and obstruction | ABVD3-151 ×6 + RT to residual3-150 disease, or ABVD3-151×6-8 + mantle for LMA Consider: ABVD ×4 + mantle (IF) RT |
| IIIA | ABVD ×6-8 + RT to residual3-150disease Consider lap for equivocal CT and LAG only |
| IIIB and IV | ABVD3-151 ×6-8 + RT to limited residual3-150disease |
| Clinical Stage . | Primary Treatment . |
|---|---|
| I and II | |
| Very favorable | |
| Female; IA, IIA NSHD or ≤3 nodal sites and <26 yr Male; IA LPHD, neck or groin Age 11-60 yr ESR <50 No restrictions listed below | EF RT Consider: Mantle (IF) RT after negative lap; ABVD ×6 for smokers and females <27 |
| Favorable | |
| ≤3 nodal sites ESR <50 No restrictions listed below | EF RT after negative lap, or ABVD ×6 + RT to residual3-150disease, Consider: ABVD ×4 + mantle (IF) RT ABVD ×6 for smokers and females <27 |
| Unfavorable | |
| >3 nodal sites LMA or bulky (≥10 cm) adenopathy ESR >50 Fever and/or weight loss Bilateral hilar adenopathy Involvement of pericardium, pleura, lung or bone Gross lymphatic permeation and obstruction | ABVD3-151 ×6 + RT to residual3-150 disease, or ABVD3-151×6-8 + mantle for LMA Consider: ABVD ×4 + mantle (IF) RT |
| IIIA | ABVD ×6-8 + RT to residual3-150disease Consider lap for equivocal CT and LAG only |
| IIIB and IV | ABVD3-151 ×6-8 + RT to limited residual3-150disease |
Treatments in italics are supported by limited or indirect data. See text for details.
Abbreviations: EF, extended field; IF, involved field; LAG, lymphangiogram; Lap, laparotomy; LMA, large mediastinal adenopathy (≥ chest diameter); PET, positive emission tomography; RT, radiation therapy; MOPP, nitrogen mustard 6 mg/m2 and vincristine 1.4 mg/m2 (maximum 2 mg) intravenous (IV) days 1 and 8, procarbazine 100 mg/m2orally days 1-10, prednisone 40 mg/m2 orally days 1-14; 28-day cycles; ABVD, doxorubicin 25 mg/m2, vinblastine 6 mg/m2 bleomycin 15 U and DTIC (immidazole carboxamide) 375 mg/m2 all IV; days 1 and 14 of a 28-day cycle; MOPP/ABVD, alternating 28-day cycles of MOPP and ABVD.
Residual radiographic abnormalities on CT scan without gallium or PET positivity are not considered residual disease.
Consider MOPP/ABVD × 6-8 in those <40 years with poor prognostic features.