Classical lymphomas constitute about 95% of all Hodgkin's lymphomas with most affected patients being between the ages of 20 and 30 years of age. The risk then drops until around 50 years, whereby the risk increases again.
Classical Hodgkin's lymphoma is separated into four subgroups:
- Nodular sclerosing type I and II – 45 %
- Mixed type – 40 %
- Lymphocyte-poor – 5 %
- Lymphocyte-rich – 5 %
When starting first-line treatment, the goal is almost always to cure the disease. Also in cases of recurrence, curative treatment is usually intended. The prognosis is best for younger patients. Treatment is adapted for the stage of the disease, but also according to specific risk factors. The university hospitals are responsible for this treatment in Norway.
|Photomicrograph of classical Hodgkin's lymphoma.
HE-stained to the left. CD15-stained upper right and CD30-stained lower right.
Chemotherapy for localized classical Hodgkin's lymphoma (stages IA and IIA)
The treatment program created by the Nordic lymphoma group for these stages includes two to four courses of the ABVD regimen with addition of 'modified involved field' radiation therapy.
Chemotherapy for advanced Hodgkin's lymphoma (stages IIB – IV)
For advanced classic Hodgkin's lymphoma in stages IIB - IV, combination chemotherapy is given and is sometimes supplemented with smaller fields of radiation therapy. Until recently, the ABVD regimen has been the gold standard for treating patients with advanced Hodgkin's lymphoma in Norway and in many other countries. Based on results from a three-armed randomized phase III study directed by the German Hodgkin group where COPP/ABVD, BEACOPP standard, and BEACOPP dose-escalation is compared, Norway has modified the treatment scheme somewhat. This applies to patients with advanced disease and poor prognosis.
ABVD chemotherapy for six to eight cycles for stages IIB and III-IV A/B with less than four favorable prognostic factors, 20–60 years
Where complete remission is reached after two cycles, six cycles are given together. One may also stop at six cycles in cases where partial remission is reached after two cycles, but further regression is observed after four and six cycles, in such cases the absence of regression may be explained by residual tumors consisting of fibrosis. If uncertain, a PET-CT scan is recommended. Otherwise, eight cycles of ABVD are given.
BEACOPP chemotherapy in eight courses for stages IIB and III-IV A/B with four or more negative unfavorable prognostic factors, 20–60 years
Based on results from a three-armed study conducted by the german Hodgkin's group as mentioned above, it has been decided in Norway to give two cycles of dose-escalated BEACOPP with growth factor support followed by six standard BEACOPP cycles to patients with four or more negative prognostic factors. This constitutes about 20% of patients with advanced Hodgkin's lymphoma. Suitable patients under 65 years of age with three or more negative prognostic factors are currently included in an international study.