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Reducing the Intensity of Therapy for Early-Stage Hodgkin Lymphoma

Andy Godfrey and Christopher McNamara

Early-stage Hodgkin lymphoma (HL) is an exquisitely chemo- and radio-sensitive hematological malignancy that has seen considerable evolution in standards-of-care over the last 20 years. A significant number of patients are cured, but with prolonged follow-up the burden of the late effects of chemotherapy and radiotherapy on a relatively young patient population has become clear. In many cases, these effects have occurred late enough so that they were not reported in the original evidence-base, which included only 5–10 years of follow-up. Study design in HL must therefore focus not only on the question of effective disease control but also on reducing the long-term toxicities of therapy.

For younger patients with early-stage disease, there is a growing body of evidence that reducing the intensity of treatment – mainly through risk stratification before and throughout treatment – may yield a better overall outcome at the cost of a small reduction in disease control with first-line therapy. This review aims to summarize the current literature surrounding the treatment of early-stage HL and the ongoing research that may shape our management of this disease in the future.

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