Hodgkin's disease: The next decade

Although treatment of Hodgkin's disease has been extensively studied in the past, fewer clinical studies are being reported, despite the fact that the optimal therapy for each stage has not yet been established. The pathologic subtypes have not been officially changed for years, although lymphocyte-predominant disease may be unrelated to the other subtypes, lymphocyte depleted histology may really be a T-cell large-cell lymphoma, mixed cellularity represents a spectrum of disease, and some cases remain unclassifiable. Staging has also still not been completely standardized, mainly because of reliance on the lymphangiogram and the staging laparotomy, which are being less commonly performed for treatment planning. Investigators still question the value of the gallium scan, magnetic resonance imaging, and abdominal ultrasound for treatment planning, and the role of these tests in the era of managed care is not defined. Finally, because treatment for the disease is so effective, the merit of each treatment plan may eventually be weighed in terms of emotional, social, and financial costs to the patient. For patients with early-stage (I-II) disease, only limited toxicity is acceptable; for patients with bulky stage II or stage III disease, combined modality therapy must be considered standard therapy, but investigators must find ways to lessen toxicity of radiotherapy and intensive chemotherapy. Finally, for patients with stage IV disease, ongoing studies of patients at high risk of relapse may reveal which will benefit from bone marrow or peripheral stem-cell transplantation as initial therapy.