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Dr. Bartlett on Treatment Regimens for Patients With Hodgkin Lymphoma

Nancy Bartlett, MD
Published: Thursday, Oct 25, 2018



Nancy Bartlett, MD, Koman Chair in Medical Oncology, Washington University School of Medicine, Siteman Cancer Center, discusses treatment regimens for patients with Hodgkin lymphoma.

Therapeutic regimens for patients with stage III and IV Hodgkin lymphoma should be divided by those for patients under 60 and over 60, says Bartlett. For patients under 60, there are 3 options that a physician can use. The standard option is often termed the RATHL approach in which patients get 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). If they have a negative interim PET scan, then they get 4 cycles of AVD, thereby eliminating bleomycin.

A second option for high-risk patients is to start with 2 cycles of escalated BEACOPP. If patients have a negative PET scan, then physicians can de-escalate to ABVD for 4 cycles. Patients had very favorable results with that regimen, notes Bartlett, with a 4-year progression-free survival (PFS) of over 90%. The third option is ABVD plus brentuximab vedotin (Adcetris; A+AVD). The regimen demonstrated a statistically significant improvement in PFS versus ABVD in the phase III ECHELON-1 trial.

Patients over 60 can receive sequential therapies such as brentuximab vedotin for 2 cycles. Then, 6 cycles of AVD with no bleomycin and 4 more doses of brentuximab. AVD can also be utilized in these patients. Bartlett notes that these patients are not suitable for A+AVD and any exposure to bleomycin.


Nancy Bartlett, MD, Koman Chair in Medical Oncology, Washington University School of Medicine, Siteman Cancer Center, discusses treatment regimens for patients with Hodgkin lymphoma.

Therapeutic regimens for patients with stage III and IV Hodgkin lymphoma should be divided by those for patients under 60 and over 60, says Bartlett. For patients under 60, there are 3 options that a physician can use. The standard option is often termed the RATHL approach in which patients get 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). If they have a negative interim PET scan, then they get 4 cycles of AVD, thereby eliminating bleomycin.

A second option for high-risk patients is to start with 2 cycles of escalated BEACOPP. If patients have a negative PET scan, then physicians can de-escalate to ABVD for 4 cycles. Patients had very favorable results with that regimen, notes Bartlett, with a 4-year progression-free survival (PFS) of over 90%. The third option is ABVD plus brentuximab vedotin (Adcetris; A+AVD). The regimen demonstrated a statistically significant improvement in PFS versus ABVD in the phase III ECHELON-1 trial.

Patients over 60 can receive sequential therapies such as brentuximab vedotin for 2 cycles. Then, 6 cycles of AVD with no bleomycin and 4 more doses of brentuximab. AVD can also be utilized in these patients. Bartlett notes that these patients are not suitable for A+AVD and any exposure to bleomycin.



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