Hodgkin Lymphoma Treatment Regimens
|
|
|
|
|
|
Hodgkin Lymphoma Treatment Regimens |
|
|
Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment. |
|
|
Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced health care team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are provided only to supplement the latest treatment strategies. These Guidelines are a work in progress that may be refined as often as new significant data become available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way. |
|
|
Note: All recommendations are category 2A unless otherwise indicated. |
|
|
▶CHL (Age ≥18 years)1,a |
|
|
REGIMEN |
DOSING |
|
Stage IA, IIA Favorable (Non-Bulky) CHL1,a |
|
|
Primary Treatment |
|
|
ABVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles followed by additional therapy. |
|
Additional Therapy |
|
|
ABVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 1–2 cycles or combined modality (based on Deauville score). |
|
AVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4 cycles following 2 cycles of ABVD. |
|
Stage I-II Unfavorable (B symptoms or bulky mediastinal disease or >10cm adenopathy) CHL1,a |
|
|
Primary Treatment |
|
|
ABVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles followed by additional therapy. |
|
Additional Therapy |
|
|
ABVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles following 2 cycles of ABVD. |
|
AVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4 cycles, following 2 cycles of ABVD. |
|
Escalated BEACOPP |
Day 1: Doxorubicin 35mg/m2 IV push Day 1: Cyclophosphamide 1,250mg/m2 IV over 1 hour Day 1: Mesna 250mg/m2 IV over 15 minutes three times daily (one dose before cyclophosphamide, then at 4 and 8 hours from the start of each cyclophosphamide dose) Days 1-3: Etoposide 200mg/m2 IV over 1 hour daily Days 1-14: Prednisone 40mg/m2 orally daily Days 1-7: Procarbazine 100mg/m2 orally daily Day 8: Bleomycin 10units/m2 IV over 10 minutes Day 8: Vincristine 1.4mg/m2 (maximum 2mg) IV over 5-10 minutes. Repeat cycle every 3 weeks for 2–4 cycles following 2 cycles of ABVD dependent on Deauville score. |
|
Stage III-IV CHL1,a |
|
|
Primary Treatment |
|
|
Preferred |
|
|
ABVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles. |
|
Other Recommended Regimen |
|
|
Brentuximab vedotin + AVD |
Days 1 and 15: Brentuximab vedotin 1.2mg/kg (maximum dosing weight is 100kg) IV over 30 minutes within 1 hour after completion of AVD Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 6 cycles. |
|
Useful in certain circumstances |
|
|
Escalated BEACOPP |
Day 1: Doxorubicin 35mg/m2 IV push Day 1: Cyclophosphamide 1,250mg/m2 IV over 1 hour Day 1: Mesna 250mg/m2 IV over 15 minutes three times daily (one dose before cyclophosphamide, then at 4 and 8 hours from the start of each cyclophosphamide dose) Days 1-3: Etoposide 200mg/m2 IV over 1 hour daily Days 1-14: Prednisone 40mg/m2 orally daily Days 1-7: Procarbazine 100mg/m2 orally daily Day 8: Bleomycin 10units/m2 IV over 10 minutes Day 8: Vincristine 1.4mg/m2 (maximum 2mg) IV over 5-10 minutes. Repeat cycle every 3 weeks for 2 cycles. |
|
Additional Therapy |
|
|
A(B)VD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4 cycles OR repeat cycle every 4 weeks for a total of 6 cycles (if Bleomycin is omitted) following 2 cycles of escalated BEACOPP with Deauville 1-3 after restage with PET/CT. |
|
AVD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4 cycles following 2 cycles of ABVD or 2 cycles of BEACOPP. |
|
Escalated BEACOPP |
Day 1: Doxorubicin 35mg/m2 IV push Day 1: Cyclophosphamide 1,250mg/m2 IV over 1 hour Day 1: Mesna 250mg/m2 IV over 15 minutes three times daily (one dose before cyclophosphamide, then at 4 and 8 hours from the start of each cyclophosphamide dose) Days 1-3: Etoposide 200mg/m2 IV over 1 hour daily Days 1-14: Prednisone 40mg/m2 orally daily Days 1-7: Procarbazine 100mg/m2 orally daily Day 8: Bleomycin 10units/m2 IV over 10 minutes Day 8: Vincristine 1.4mg/m2 (maximum 2mg) IV over 5-10 minutes. Repeat cycle every 3 weeks for 2-4 dependent on Deauville score. |
|
Refractory and Suspected Relapse CHL1,a |
|
|
Second-line and Subsequent Therapy |
|
|
Brentuximab vedotin11,14,15,f |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes. Repeat cycle every 3 weeks. |
|
Brentuximab vedotin + Bendamustine11,16,17,f |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes Day 1-2: Bendamustine 90mg/m2 IV over 10-60 minutes (based on product selection) daily. Repeat cycle every 3 weeks for 6 cycles. |
|
Brentuximab vedotin + Nivolumab11,18,19,f,g |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes, followed by: Day 8, Cycle 1: Nivolumab 3mg/kg IV over 30 minutes, followed by: Day 1, Cycles 2-4: Nivolumab 3mg/kg IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
|
DHAP |
Days 1-4: Dexamethasone 40mg orally or IV daily Day 1: Cisplatin 100mg/m2 IV continuous infusion over 24 hours Day 2: Cytarabine 2,000mg/m2 IV over 3 hours every 12 hours. Repeat cycle every 3 to 4 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
ESHAP |
Days 1-4: Etoposide 40mg/m2 IV over 60 minutes daily Days 1-4: Methylprednisolone 500mg IV over 15 minutes daily Days 1-4: Cisplatin 25mg/m2 IV continuous infusion over 24 hours daily Day 5: Cytarabine 2,000mg/m2 IV over 3 hours. Repeat cycle every 3-4 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Gemcitabine/Bendamustine/ |
Days 1 and 4: Gemcitabine 800mg/m2 IV over 30 minutes Day 1: Vinorelbine 20mg/m2 IV over 5-10 minutes Days 2 and 3: Bendamustine 90mg/m2 IV over 10-60 minutes (based on product selection) daily Days 1-4: Prednisolone 100mg orally daily. Repeat cycle every 3 weeks for 4 cycles. |
|
GVD |
Days 1 and 8: Vinorelbine 20mg/m2 IV over 5-10 minutes, followed by: Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes, followed by: Days 1 and 8: Liposomal doxorubicin 15mg/m2 IV. Repeat cycle every 3 weeks for 2-6 cycles (transplant-naïve). OR Days 1 and 8: Vinorelbine 15mg/m2 IV over 5-10 minutes, followed by: Days 1 and 8: Gemcitabine 800mg/m2 IV over 30 minutes, followed by: Days 1 and 8: Liposomal doxorubicin 10mg/m2 IV. Repeat cycle every 3 weeks for 2-6 cycles (prior transplant). |
|
GVD |
Day 1: Pembrolizumab 200mg IV over 30 minutes, followed by: Days 1 and 8: Vinorelbine 20mg/m2 IV over 5-10 minutes, followed by: Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes, followed by: Days 1 and 8: Liposomal doxorubicin 15mg/m2 IV. Repeat cycle every 3 weeks for 2-4 cycles followed by evaluation for HDT/AHCT if complete response. |
|
ICE |
Inpatient: Days 1-3: Etoposide 100mg/m2 IV over 1 hour daily Day 2: Carboplatin AUC 5 IV over 30 minutes Day 2: Ifosfamide 5,000mg/m2 IV continuous infusion over 24 hours, concurrent with: Day 2: Mesna 5,000mg/m2 IV continuous infusion over 24 hours. Repeat cycle every 2-3 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). Outpatient: Days 1-3: Etoposide 100mg/m2 IV over 30 minutes daily Day 1: Carboplatin AUC 5 IV over 1 hour Days 1-3: Ifosfamide 1,667mg/m2 IV over 2-3 hours daily (total dose 5000mg/m2 over 3 days), concurrent with: Days 1-3: Mesna 1,667mg/m2 IV over 2-3 hours daily (total dose 5000mg/m2 over 3 days). Repeat cycle every 3 weeks for 2 cycles. |
|
IGEV |
Days 1-4: Mesna 400mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose) Days 1-4: Ifosfamide 2,000mg/m2 IV over 3 hours daily Days 1 and 4: Gemcitabine 800mg/m2 IV over 30 minutes Day 1: Vinorelbine 20mg/m2 IV over 5-10 minutes Days 1-4: Prednisone 100mg orally daily. Repeat cycle every 3 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Pembrolizumab27,33-35,g |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks until up to 2 years of therapy has been completed . OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat every 6 weeks until up to 2 years of therapy has been completed. |
|
Third-Line and Subsequent Systemic Therapy |
|
|
Bendamustine16,36 |
Days 1-2: Bendamustine 90-120mg/m2 IV over 10-60 minutes (based on product selection) daily. Repeat cycle every 4 weeks for a maximum of 6 cycles. |
|
Bendamustine/Carboplatin/ |
Days 1-2: Bendamustine 60-120mg/m2 IV over 10-60 minutes (based on product selection) daily Day 1: Carboplatin AUC 5 IV over 30 minutes Days 1-3: Etoposide 100mg/m2 IV over 1 hour daily. Repeat cycle every 3 weeks for a maximum of 2 cycles. |
|
C-MOPP |
Day 1: Cyclophosphamide 650mg/m2 IV over 30 minutes Day 1: Vincristine 1.4mg/m2 (maximum 2mg) IV over 5-10 minutes Days 1-14: Prednisone 40mg/m2 orally daily Days 1-7: Procarbazine 100mg/m2 orally daily. Repeat cycle every 4 weeks for 4-8 cycles (nontransplant candidates) OR Days 1 and 8: Cyclophosphamide 500mg/m2 IV over 30 minutes Days 1 and 8: Vincristine 1.4mg/m2 (maximum 2mg) IV over 5-10 minutes Days 1-3 and 8-10: Prednisone 40mg/m2 orally daily Days 1-14: Procarbazine 100mg/m2 orally daily. Repeat cycle every 4 weeks for 4-8 cycles (nontransplant patients). |
|
Everolimus42,43 |
Days 1-28: Everolimus 10mg orally daily. Repeat cycle every 4 weeks. |
|
GCD |
Days 1 and 8: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Cisplatin 75mg/m2 over 2 hours Days 1-4: Dexamethasone 40mg orally daily. Repeat cycle every 3 weeks for 2-3 cycles. |
|
GEMOX |
Day 1: Gemcitabine 1,000mg/m2 IV over 30 minutes Day 1: Oxaliplatin 100 mg/m2 IV over 2 hours. Repeat cycle every 15 or 21 days for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Lenalidomide46,47 |
Days 1-21: Lenalidomide 25mg orally daily. Repeat cycle every 4 weeks. |
|
MINE |
Days 1-3: Mesna 300 mg/m2 IV over 15 minutes three times daily (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose) Days 1-3: Ifosfamide 1,330 mg/m2 IV over 3 hours daily Day 1-3: Etoposide 65mg/m2 IV over 1 hour daily Day 1: Mitoxantrone 8mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Mini-BEAM |
Day 1: Carmustine 60mg/m2 IV over 2 hours Days 2-5: Etoposide 75mg/m2 IV over 1 hour daily Days 2-5: Cytarabine 100mg/m2 IV over 3 hours every 12 hours Day 6: Melphalan 30mg/m2 IV over 15 minutes. Repeat cycle every 4-6 weeks for 2-4 cycles (transplant and nontransplant candidates). |
|
Nivolumab18,51-53,g |
Day 1: Nivolumab 240mg IV over 30 minutes. Repeat cycle every 2 weeks. OR Day 1: Nivolumab 480mg IV over 30 minutes. Repeat cycle every 4 weeks. |
|
Pembrolizumab27,33-35,g |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks until up to 2 years of therapy has been completed. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 6 weeks until up to 2 years of therapy has been completed. |
|
Maintenance Therapy |
|
|
Brentuximab vedotin11,14,15,f |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes beginning within 4-6 weeks post-transplant or upon recovery from transplant. Repeat cycle every 3 weeks for up to 16 cycles. |
|
▶CHL (Age >60 years)1,a |
|
|
Stage I-II Favorable Disease in Older Adults (Age >60)1,a |
|
|
Preferred Regimen |
|
|
A(B)VD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles with subsequent ISRT. |
|
A(B)VD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles with subsequent ISRT followed by: Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles. Alternatively, the bleomycin may be omitted and patients may receive a total of 4 cycles of AVD alone. |
|
Other Recommended Regimen |
|
|
CHOP |
Day 1: Cyclophosphamide 750mg/m2 IV over 30 minutes Day 1: Doxorubicin 50mg/m2 IV push Day 1: Vincristine 1.4mg/m2 (maximum 2 mg) IV over 5 – 10 minutes Days 1-5: Prednisone 100mg orally daily. Repeat cycle every 3 weeks for 4 cycles with subsequent ISRT. |
|
Stage I-II Unfavorable or Stage III-IV Disease in Older Adults (Age >60) |
|
|
Suggested Treatment Regimens |
|
|
A(B)VD |
Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5-10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 2 cycles, followed by: Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 4 cycles if PET scan is negative after 2 cycles of ABVD. Alternatively, the bleomycin may be omitted and patients may receive a total of 6 cycles (or consider a total of 4 cycles for State I-II Unfavorable) of AVD alone. |
|
Brentuximab vedotin followed by AVD |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes. Repeat cycle every 3 weeks for 2 cycles, followed by: Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 6 cycles, conditionally followed by consolidation in responding patients: Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes. Repeat cycle every 3 weeks for 4 cycles. |
|
Brentuximab vedotin + DTIC |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes Day 1, Cycles 1-12: Dacarbazine 375mg/m2 IV over 30 minutes. Repeat cycle every 3 weeks. |
|
CHOP |
Day 1: Cyclophosphamide 750mg/m2 IV over 30 minutes Day 1: Doxorubicin 50mg/m2 IV push Day 1: Vincristine 1.4mg/m2 (maximum 2 mg) IV over 5-10 minutes Days 1-5: Prednisone 100mg orally daily. Repeat cycle every 3 weeks for 6 cycles with or without subsequent ISRT. |
|
Relapsed or Refractory Disease in Older Adults (Age >60) |
|
|
Suggested Palliative Therapy Treatment Regimens |
|
|
Bendamustine16,36 |
Days 1-2: Bendamustine 90-120mg/m2 IV over 10-60 minutes daily. Repeat cycle every 4 weeks for a maximum of 6 cycles. |
|
Brentuximab vedotin11,14,15,f |
Day 1: Brentuximab vedotin 1.8mg/kg (maximum dosing weight is 100kg) IV over 30 minutes. Repeat cycle every 3 weeks. |
|
Nivolumab18,51-53,g |
Day 1: Nivolumab 240 mg IV over 30 minutes. Repeat cycle every 2 weeks. OR Day 1: Nivolumab 480mg IV over 30 minutes. Repeat cycle every 4 weeks. |
|
Pembrolizumab27,33-35,g |
Day 1: Pembrolizumab 200mg IV over 30 minutes. Repeat cycle every 3 weeks until up to 2 years of therapy has been completed. OR Day 1: Pembrolizumab 400mg IV over 30 minutes. Repeat cycle every 6 weeks until up to 2 years of therapy has been completed. |
|
Second-line, third-line and subsequent therapy options (only for CHL) can be used. |
|
|
▶NLPHL1,a |
|
|
CS IB, IIB or CS 1A (Bulky)/CS IIA (Bulky or noncontiguous) NLPHL1,a |
|
|
Primary Treatment |
|
|
R-ABVD |
Day 1: Rituximab 375mg/m2 IV Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375 mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 6 cycles. |
|
R-CHOP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 750mg/m2 IV over 30 minutes Day 1: Doxorubicin 50mg/m2 IV push Days 1: Vincristine 1.4mg/m2 (maximum 2 mg) IV over 5-10 minutes Days 1-5: Prednisone 100mg orally daily, Repeat cycle every 3 weeks for 6 cycles. |
|
R-CVbP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 500mg/m2 IV over 30 minutes Days 1 and 8: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1–8: Prednisolone 40mg/m2 orally daily. Repeat cycle every 3 weeks for 3 cycles. |
|
Rituximab60,63,67-70,k,l |
Days 1,8,15,22: Rituximab 375mg/m2 IV. Administer for one 4-week cycle, followed by maintenance therapy with: Days 1,8,15,22: Rituximab 375mg/m2 IV. Repeat cycle every six months for 2 years. |
|
CS II-IV (Based on Clinical Judgement) NLPHLa |
|
|
Primary Treatment |
|
|
R-ABVD |
Day 1: Rituximab 375mg/m2 IV Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375 mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 6 cycles. |
|
R-CHOP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 750mg/m2 IV over 30 minutes Day 1: Doxorubicin 50mg/m2 IV push Days 1: Vincristine 1.4mg/m2 (maximum 2 mg) IV over 5-10 minutes Days 1-5: Prednisone 100mg orally daily, Repeat cycle every 3 weeks for 6 cycles. |
|
R-CVbP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 500mg/m2 IV over 30 minutes Days 1 and 8: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1–8: Prednisolone 40mg/m2 orally daily. Repeat cycle every 3 weeks for 3 cycles. |
|
Rituximab60,63,67-70,k,l |
Days 1,8,15,22: Rituximab 375mg/m2 IV. Administer for one 4-week cycle, followed by maintenance therapy with: Days 1,8,15,22: Rituximab 375mg/m2 IV. Repeat cycle every 6 months for 2 years. |
|
Refractory and Suspected Relapse NLPHLa |
|
|
Primary Treatment |
|
|
Rituximab60,63,67-70,k,l |
Days 1,8,15,22: Rituximab 375mg/m2 IV. Administer for one 4-week cycle, followed by maintenance therapy with: Days 1,8,15,22: Rituximab 375mg/m2 IV. Repeat cycle every six months for 2 years. |
|
Rituximab + Bendamustine16,60,71,72,k,l |
Days 1-2: Bendamustine 90-120mg/m2 IV over 10-60 minutes (based on product selection) daily Day 1: Rituximab 375mg/m2 IV. Repeat cycle every 4 weeks for a maximum of 6 cycles. |
|
Rituximab + DHAP |
Day 1: Rituximab 375mg/m2 IV Days 1-4: Dexamethasone 40mg orally or IV daily Day 1: Cisplatin 100mg/m2 IV continuous infusion over 24 hours Day 2: Cytarabine 2,000mg/m2 IV over 3 hours every 12 hours. Repeat cycle every 3-4 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Rituximab + ESHAP |
Day 1: Rituximab 375mg/m2 IV Days 1-4: Etoposide 40mg/m2 IV over 60 minutes daily Days 1-4: Methylprednisolone 500mg IV over 15 minutes daily Days 1-4: Cisplatin 25mg/m2 IV continuous infusion over 24 hours daily Day 5: Cytarabine 2,000mg/m2 IV over 3 hours. Repeat cycle every 3-4 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
Rituximab + ICE |
Inpatient: Day 1: Rituximab 375mg/m2 IV Days 1-3: Etoposide 100mg/m2 IV over 1 hour daily Day 2: Carboplatin AUC 5 IV over 30 minutes Day 2: Ifosfamide 5,000mg/m2 IV continuous infusion over 24 hours, concurrent with: Day 2: Mesna 5,000mg/m2 IV continuous infusion over 24 hours. Repeat cycle every 2-3 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). Outpatient: Day 1: Rituximab 375mg/m2 IV Days 1-3: Etoposide 100mg/m2 IV over 30 minutes daily Day 1: Carboplatin AUC 5 IV over 1 hour Days 1-3: Ifosfamide 1,667mg/m2 IV over 2-3 hours daily (total dose 5000mg/m2 over 3 days), concurrent with: Days 1-3: Mesna 1,667mg/m2 IV over 2-3 hours daily (total dose 5000mg/m2 over 3 days). Repeat cycle every 3 weeks for 2 cycles. |
|
Rituximab + IGEV |
Day 1: Rituximab 375mg/m2 IV Days 1-4: Mesna 400mg/m2 IV over 15 minutes three times day (one dose before ifosfamide, then at 4 and 8 hours from the start of each ifosfamide dose on Days 1-4) Days 1-4: Ifosfamide 2,000mg/m2 IV over 3 hours daily Days 1 and 4: Gemcitabine 800mg/m2 IV over 30 minutes Day 1: Vinorelbine 20mg/m2 IV over 5-10 minutes Days 1-4: Prednisone 100mg orally daily. Repeat cycle every 3 weeks for 2-4 cycles (transplant candidates) or 4-8 cycles (nontransplant candidates). |
|
If Not Previously Used: |
|
|
R-ABVD |
Day 1: Rituximab 375mg/m2 IV Days 1 and 15: Doxorubicin 25mg/m2 IV push Days 1 and 15: Bleomycin 10units/m2 IV over 10 minutes Days 1 and 15: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1 and 15: Dacarbazine 375 mg/m2 IV over 30 minutes. Repeat cycle every 4 weeks for 6 cycles. |
|
R-CHOP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 750mg/m2 IV over 30 minutes Day 1: Doxorubicin 50mg/m2 IV push Days 1: Vincristine 1.4mg/m2 (maximum 2 mg) IV over 5 – 10 minutes Days 1-5: Prednisone 100mg orally daily, Repeat cycle every 3 weeks for 6 cycles. |
|
R-CVbP |
Day 1: Rituximab 375mg/m2 IV Day 1: Cyclophosphamide 500mg/m2 IV over 30 minutes Days 1 and 8: Vinblastine 6mg/m2 IV over 5–10 minutes Days 1–8: Prednisolone 40mg/m2 orally daily. Repeat cycle every 3 weeks for 3 cycles. |
|
a AHCT = autologous hematopoietic cell transplant; CHL = classic Hodgkin Lymphoma; CS = clinical stage; HDT = high-dose therapy; NLPHL = nodular lymphocyte predominant Hodgkin Lymphoma. b Consider premedication for anaphylactoid reaction for Bleomycin: acetaminophen 650mg orally 30-60 minutes pre-bleomycin and/or diphenhydramine 12.5-50mg IV or orally 30-60 minutes pre-bleomycin. c Doxorubicin is an anthracycline. Cumulative anthracycline dosage should be monitored. d Administration of myeloid growth factors are recommended for this regimen. e Oral hydration is strongly encouraged with Cyclophosphamide; poorly hydrated patients may need supplement IV hydration. Patients should attain combined oral and IV hydration of 2,000 to 3,000mL/day on day of chemotherapy. f Consider premedication for Brentuximab vedotin for hypersensitivity: acetaminophen 650-1,000mg orally 30-60 minutes pre-brentuximab vedotin AND diphenhydramine 12.5-50mg IV or orally 30-60 minutes pre-brentuximab vedotin WITH OR WITHOUT corticosteroid per institution protocol 30-60 minutes pre-brentuximab vedotin (consider for subsequent infusions if prior reaction). g Early- and late-onset immune-related adverse events affecting multiple organ systems can occur in patients receiving immune checkpoint inhibitors. Patients with neurologic or life-threatening autoimmune disorders as well as those receiving high levels of immunosuppression for their underlying disease should be approached with caution when considering immunotherapy. All patients will require extensive resources including ongoing intensive monitoring and supportive care. h Hydration is required with supplemental electrolytes pre- and post-administration of Cisplatin. i Do not substitute with standard Doxorubicin on a mg per mg basis. Product doses are different. j Hydration is required pre- and post-administration of Ifosfamide. k An FDA-approved biosimilar is an acceptable substitution for Rituximab. l For Rituximab: Premedication for infusion reactions is required. The recommended dosing is: Diphenhydramine 12.5-50mg IV/orally 30-60 minutes pre-Rituximab AND Acetaminophen 650mg orally 30-60 minutes pre-Rituximab. |
|
|
References |
|
|
1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hodgkin Lymphoma V.2.2022: Available at: https://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf. Accessed August 20, 2022. 2. Engert A, Plütschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med. 2010;363(7):640-652. 3. Radford J, Illidge T, Counsell N, et al. Results of a trial of PET-directed therapy for early-stage Hodgkin’s lymphoma. N Engl J Med. 2015;372(17):1598-1607. 4. André MPE, Girinsky T, Federico M, et al. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: Final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017;35(16):1786-1794. 5. Straus DJ, Jung SH, Pitcher B, et al. CALGB 50604: risk-adapted treatment of nonbulky early-stage Hodgkin lymphoma based on interim PET. Blood. 2018;132(10):1013-1021. 6. Fuchs M, Goergen H, Kobe C, et al. Positron emission tomography-guided treatment in early-stage favorable hodgkin lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group. J Clin Oncol. 2019;37(31):2835-2845. 7. Johnson P, Federico M, Kirkwood A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin’s Lymphoma. N Engl J Med. 2016;374(25):2419-2429. 8. Avigdor A, Bulvik S, Levi I, et al. Two cycles of escalated BEACOPP followed by four cycles of ABVD utilizing early-interim PET/CT scan is an effective regimen for advanced high-risk Hodgkin’s lymphoma. Ann Oncol. 2010;21(1):126-132. 9. Casasnovas RO, Bouabdallah R, Brice P, et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019;20(2):202-215. 10. Engert A, Haverkamp H, Kobe C, et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012;379(9828):1791-1799. 11. Brentuximab vedotin (Adcetris) [package insert] Bothell, WA: Seagen Inc.; February 2022. https://seagendocs.com/Adcetris_Full_Ltr_Master.pdf. Accessed August 21, 2022. 12. Straus DJ, Długosz-Danecka M, Connors JM, et al. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021;8(6):e410-e421. 13. Borchmann P, Goergen H, Kobe C, et al. PET-guided treatment in patients with advanced-stage Hodgkin’s lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet. 2017;390(10114):2790-2802. 14. Moskowitz CH, Nademanee A, Masszi Ti, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin’s lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385(9980):1853-1862. 15. Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin’s lymphoma. J Clin Oncol. 2012;30(18):2183-2189. 16. Bendamustine (Bendeka) [package insert] Parsippany, NJ: Teva Pharmaceuticals USA, Inc.; October 2021. https://www.bendekahcp.com/globalassets/bendeka-hcp/prescribinginformation.pdf. Accessed August 21,2022. 17. O’Connor OA, Lue JK, Sawas A, et al. Brentuximab vedotin plus bendamustine in relapsed or refractory Hodgkin’s lymphoma: an international, multicentre, single-arm, phase 1-2 trial. Lancet Oncol. 2018;19(2):257-266. 18. Nivolumab (Opdivo) [package insert] Princeton, NJ: Bristol-Myers Squibb Company; July 2022. https://packageinserts.bms.com/pi/pi_opdivo.pdf. Accessed August 17, 2022. 19. Herrera AF, Moskowitz AJ, Bartlett NL, et al. Interim results of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory lymphoma. Blood. 2018;131(11):1183-1194. 20. Josting A, Rudolph C, Reiser M, et al. Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin’s disease. Ann Oncol. 2002;13(10):1628-1635. 21. Abali H, Urün Y, Oksüzoğlu B, et al. Comparison of ICE (ifosfamide-carboplatin-etoposide) versus DHAP (cytosine arabinoside-cisplatin- dexamethasone) as salvage chemotherapy in patients with relapsed or refractory lymphoma. Cancer Invest. 2008;26(4):401-406. 22. Aparicio J, Segura A, Garcerá S, et al. ESHAP is an active regimen for relapsing Hodgkin’s disease. Ann Oncol. 1999;10(5):593-595. 23. Labrador J, Cabrero-Calvo M, Pérez-López E, et al. ESHAP as salvage therapy for relapsed or refractory Hodgkin’s lymphoma. Ann Hematol. 2014;93(10):1745-1753. 24. Fernández de Larrea C, Martínez C, Gaya A, et al. Salvage chemotherapy with alternating MINE-ESHAP regimen in relapsed or refractory Hodgkin’s lymphoma followed by autologous stem cell transplantation. Ann Oncol. 2010;21(6):1211-1216. 25. Santoro A, Mazza R, Pulsoni A, et al. Bendamustine in combination with gemcitabine and vinorelbine is an effective regimen as induction chemotherapy before autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma: final results of a multicenter phase II study. J Clin Oncol. 2016;34(27):3293-3299. 26. Bartlett NL, Niedzwiecki D, Johnson JL, et al. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Ann Oncol. 2007;18(6):1071-1079. 27. Pembrolizumab (Keytruda) [package insert] Whitehouse Station, NJ: Merck & Co., Inc.; August 2022. https://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_pi.pdf. Accessed August 17, 2022. 28. Moskowitz AJ, Shah G, Schöder H, et al. Phase II trial of pembrolizumab plus gemcitabine, vinorelbine, and liposomal doxorubicin as second-line therapy for relapsed or refractory classical Hodgkin lymphoma. J Clin Oncol. 2021;39(28):3109-3117. 29. Moskowitz CH, Nimer SD, Zelenetz AD, et al. A 2-step comprehensive high- dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model. Blood. 2001;97(3):616-623. 30. Moskowitz CH, Nimer SD, Glassman JR, etal. The International Prognostic Index predicts for outcome following autologous stem cell transplantation in patients with relapsed and primary refractory intermediate-grade lymphoma. Bone Marrow Transplant. 1999;23(6):561-567. 31. Hertzberg MS, Crombie C, Benson W, et al. Outpatient fractionated ifosfamide, carboplatin and etoposide as salvage therapy in relapsed and refractory non- Hodgkin’s and Hodgkin’s lymphoma. Ann Oncol. 2006;17 Suppl 4:iv25-30. 32. Santoro A, Magagnoli M, Spina M, et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica. 2007;92(1):35-41. 33. Chen R, Zinzani PL, Fanale MA, et al. Phase II study of the efficacy and safety of pembrolizumab for relapsed/refractory classic Hodgkin lymphoma. J Clin Oncol. 2017;35(19):2125-2132. 34. Kuruvilla J, KEYNOTE-204 investigators. Pembrolizumab for relapsed or refractory Hodgkin lymphoma – Author’s reply. Lancet Oncol. 2021;22(6):e235. 35. Lala M, Ruoso Li T, de Alwis DP, et al. A six-weekly dosing schedule for pembrolizumab in patients with cancer based on evaluation using modelling and simulation. Eur J Cancer. 2020;131:68-75. 36. Moskowitz AJ, Hamlin PA, Perales M-A, et al. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol. 2013;31(4):456-460. 37. Budde LE, Wu D, Martin DB, et al. Bendamustine with rituximab, etoposide and carboplatin (T(R)EC) in relapsed or refractory aggressive lymphoma: a prospective multicentre phase 1/2 clinical trial. Br J Haematol. 2018;183(4):601-607. 38. Montoto S, Camós M, López-Guillermo A, et al. Hybrid chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (C-MOPP/ABV) as first-line treatment for patients with advanced Hodgkin disease. Cancer. 2000;88(9):2142-2148. 39. Longo DL, Young RC, Hubbard SM, et al. Prolonged initial remission in patients with nodular mixed lymphoma. Ann Intern Med. 1984;100(5):651-656. 40. Anderson T, Bender RA, Fisher RI, et al. Combination chemotherapy in non- Hodgkin’s lymphoma: results of long-term followup. Cancer Treat Rep. 1977;61(6): 1057-1066. 41. Takenaka T, Mikuni C, Miura A, et al. Alternating combination chemotherapy C-MOPP (cyclophosphamide, vincristine, procarbazine, prednisone) and ABVd (adriamycin, bleomycin, vinblastine, dacarbazine) in clinical stage II-IV Hodgkin’s disease: a multicenter phase II study (JCOG 8905). The Lymphoma Study Group of the Japan Clinical Oncology Group. Jpn J Clin Oncol. 2000;30(3):146-152. 42. Everolimus (Afinitor) [package insert] East Hanover, NJ: Novartis Pharmaceuticals Corporation., Inc.; February 2022. https://www.novartis.com/us-en/sites/novartis_us/files/afinitor.pdf. Accessed August 17, 2022. 43. Johnston PB, Inwards DJ, Colgan JP, et al. A phase II trial of the oral mTOR inhibitor everolimus in relapsed Hodgkin lymphoma. Am J Hematol. 2010;85(5):320-324. 44. Crump M, Kuruvilla J, Couban S, et al. Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12. J Clin Oncol. 2014;32(31):3490-3496. 45. Gutierrez A, Rodriguez J, Martinez-Serra J, et al. Gemcitabine and oxaliplatinum: an effective regimen in patients with refractory and relapsing Hodgkin lymphoma. Onco Targets Ther. 2014;7:2093-2100. 46. Lenalidomide (Revlimid) [package insert] Summit. NJ: Celgene Corporation; May 2022. https://packageinserts.bms.com/pi/pi_revlimid.pdf. Accessed September 7, 2022. 47. Fehniger TA, Larson S, Trinkaus K, et al; A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood. 2011;118(19): 5119-5125. 48. Rodriguez MA, Cabanillas FC, Velasquez W, et al. Results of a salvage treatment program for relapsing lymphoma: MINE consolidated with ESHAP. J Clin Oncol. 1995;13(7):1734-1741. 49. Colwill R, Crump M, Couture F, et al. Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin’s disease before intensive therapy and autologous bone marrow transplantation. J Clin Oncol. 1995;13(2):396-402. 50. Martín A, Fernández-Jiménez MC, Caballero MD, et al. Long-term follow-up in patients treated with Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin’s disease. Br J Haematol. 2001;113(1):161-171. 51. Ansell SM, Lesokhin AM, Borrello I, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma. N Engl J Med. 2015;372(4):311-319. 52. Timmerman JM, Engert A, Younes A, et al. Checkmate 205 update with minimum 12-month follow up: A phase 2 study of nivolumab in patients with relapsed/refractory classical Hodgkin lymphoma. Blood. 2016;128(22):1110. 53. Younes A, Santoro A, Shipp M, et al. Nivolumab for classical Hodgkin’s lymphoma after failure of both autologous stem-cell transplantation and brentuximab vedotin: a multicentre, multicohort, single-arm phase 2 trial. Lancet Oncol. 2016;17(9):1283-1294. 54. Stamatoullas A, Brice P, Bouabdallah R, et al. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol. 2015;170(2):179-184. 55. Behringer K, Goergen H, Hitz F, et al. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin’s lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet. 2015;385(9976):1418-1427. 56. Kolstad A, Nome O, Delabie J, et al. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin’s lymphoma. Leuk Lymphoma. 2007;48(3):570-576. 57. Evens AM, Advani RH, Helenowski IB, et al. Multicenter phase II study of sequential brentuximab vedotin and doxorubicin, vinblastine, and dacarbazine chemotherapy for older patients with untreated classical Hodgkin lymphoma. J Clin Oncol. 2018;36(30):3015-3022. 58. Friedberg JW, Forero-Torres A, Bordoni RE, et al. Frontline brentuximab vedotin in combination with dacarbazine or bendamustine in patients aged ≥60 years with HL. Blood. 2017;130(26):2829-2837. 59. Friedberg JW, Forero-Torres A, Holkova B, et al. Long-term follow-up of brentuximab vedotin ± dacarbazine as first line therapy in elderly patients with Hodgkin lymphoma. J Clin Oncol. 2018;36(suppl 15):abstract 7542. 60. Rituximab (Rituxan) [package insert] South San Francisco, CA: Genentech, Inc.; December 2021. https://www.gene.com/download/pdf/rituxan_prescribing.pdf. Accessed August 17, 2022. 61. Savage KJ, Skinnider B, Al-Mansour M, et al. Treating limited stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. 2011;118:4585-4590. 62. Canellos GP, Mauch P. What is the appropriate systemic chemotherapy for lymphocyte-predominant Hodgkin’s Lymphoma? J Clin Oncol. 2010;28:e8. 63. Advani RH, Hoppe RT. How I treat nodular lymphocyte predominant Hodgkin lymphoma. Blood. 2013;122 (26):4182-4188. 64. Fanale MA, Cheah CY, Rich A, et al. Encouraging activity for R-CHOP in advanced stage nodular lymphocyte-predominant Hodgkin lymphoma. Blood. 2017;130(4):472- 477. 65. Unal A, Sari I, Deniz K, et al. Familial nodule lymphocyte predominant Hodgkin lymphoma: Successful treatment with CHOP plus rituximab. Leuk Lymphoma. 2005;46(11):1613-1617. 66. Shankar A, Hall GW, Gorde-Grosjean S, et al. Treatment outcome after low intensity chemotherapy [CVP] in children and adolescents with early stage nodular lymphocyte predominant Hodgkin’s lymphoma – an Anglo-French collaborative report. Eur J Cancer. 2012;48(11):1700-1706. 67. Advani RH, Horning SJ, Hoppe RT, et al. Mature results of a phase II study of rituximab therapy for nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol. 2014;32(9):912-918. 68. Schulz H, Rehwald U, Morschhauser F, et al. Rituximab in relapsed lymphocyte- predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. 2008;111(1):109-111. 69. Eichenauer DA, Fuchs M, Pluetschow A, et al. Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group. Blood. 2011;118(16):4363-4365. 70. Eichenauer DA, Plutschow A, Fuchs M, et al. Long-term course of patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma: A report from the German Hodgkin Study Group. J Clin Oncol. 2015;33(26):2857-2862. 71. Prusila REI, Haapasaari KM, Marin K, et al. R-Bendamustine in the treatment of nodular lymphocyte-predominant Hodgkin lymphoma. Acta Oncol. 2018 Sep;57(9):1265-1267. 72. Cheson BD, Brugger W, Damaj G, et al. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel – an update. Leuk Lymphoma. 2016;57(4):766-782. |
|
|
(Revised 9/2022; NCCN Hodgkin Lymphoma Guidelines v2.2022) © 2022 by Haymarket Media, Inc. |
|
