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Treatment of early-stage nonbulky Hodgkin lymphoma

Straus, David J

doi: 10.1097/01.cco.0000239880.39086.94

Purpose of review Excellent results have been achieved in the treatment of early-stage Hodgkin lymphoma for more than 30 years with radiation therapy alone or the combined modalities of radiotherapy and chemotherapy. A major concern has been the long-term toxicity of treatment, most of which is attributable to radiotherapy. Recent trials that attempt to decrease acute and long-term toxicity are reviewed.

Recent findings To address the problem of late treatment morbidity, randomized trials of combined-modality therapy have been conducted demonstrating that the number of chemotherapy cycles and the extent and doses of radiotherapy can be reduced. Several studies, including three randomized trials of chemotherapy alone vs. combined-modality therapy, suggest that chemotherapy alone is a reasonable option for the treatment of nonbulky early-stage Hodgkin lymphoma. Positron emission tomography after one or two cycles of chemotherapy has been found to be highly predictive of treatment outcome for Hodgkin lymphoma. Combination chemotherapy alone including gemcitabine, a highly active drug with a favorable toxicity profile, with positron emission tomography early during treatment is under evaluation.

Summary Less toxic regimens with the aid of positron emission tomography may reduce the short-term and long-term toxicities of treatment of early-stage nonbulky Hodgkin lymphoma.

Memorial Sloan-Kettering Cancer Center, Professor of Clinical Medicine, Weill Medical College of Cornell University, New York, New York, USA

Correspondence to David J. Straus, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 406, NY, NY 10021 USA Tel: +212 639 8365; fax: +646 422 2291; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.