Dr. Diehl Compares US and EU Hodgkin Lymphoma Staging

Volker Diehl, MD, Professor of Medicine, Emeritus, University of Cologne, Germany, explains the differences between the staging of Hodgkin Lymphoma in the US and Europe.

Western countries such as the US and Canada use 2 stages for Hodgkin's Lymphoma: early and advanced. In Europe 3 stages exist: early, intermediate, and advanced. Because of these differences in staging practice roughly 30-35% of what would be the European intermediate stage is bundled into the advanced section in the US. The lack of an intermediate level may result in the over treating of patients.

Diehl explains that a patient diagnosed with a stage I bulk, with B symptoms, Hodgkin Lymphoma would receive 6 courses over 6 months of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) in the US, but would only receive 2 doses over the span of 2 1/2 months in Europe.

The extra courses received in the US opens patients up to more adverse reactions. The side effects of adriamycin are cardiotoxicity and bleomycin can result in lung toxicities. Diehl questions whether the advantages of the extra chemotherapy outweigh the risks involved with the ABVD treatment.