Reduced intensity treatment in early-stage Hodgkin's lymphoma

Early-stage Hodgkin's lymphoma which includes patients with Ann Arbor stages I or II, accounts for more than 50% of all cases of the illness and is curable in a high proportion of patients. Long-term follow-up has shown that the mortality in favorable-risk patients with early-stage Hodgkin's lymphoma is exceeded by other causes including secondary malignancies and cardiac disease. Over the decades the treatment paradigm in Hodgkin's lymphoma has evolved from extended field radiotherapy to combined modality therapy using involved field radiotherapy to using chemotherapy alone. The data on long-term complications from using low dose and limited field radiation therapy is still awaited since we know that most of the secondary malignancies occur late (ie, more than 10 years after the treatment). By changing the chemotherapy regimens from mechlorethamine, vincristine, procarbazine, prednisone (MOPP) to doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) the incidence of infertility and leukemia has been reduced. Since the late toxicity was high with radiotherapy, recent studies have focused on using chemotherapy alone. The results of interim positron emission tomography (PET) scans after two cycles of chemotherapy are being tested to see whether minimizing therapy in rapidly-responding patients will still maintain excellent cure rates. Here, we have reviewed some of the important clinical trials in early-stage Hodgkin's lymphoma and focus on some of the recent trials emphasizing reduced intensity treatment in early-stage Hodgkin's lymphoma.