Early-stage classical Hodgkin lymphoma (stage I to II)
Early-stage classical Hodgkin lymphoma is Hodgkin lymphoma confined to one or two lymph node regions on one side of the diaphragm, one of the most curable cancers, with most patients cured by a short course of ABVD chemotherapy with or without radiotherapy to the involved nodes. Because patients are young, trials now use PET scans after two cycles to give as little treatment as safely possible.
Overview
Classical Hodgkin lymphoma is a B-cell lymphoma in which the malignant Hodgkin and Reed-Sternberg cells, CD30 and CD15 positive and usually CD20 negative, are outnumbered by a reactive inflammatory background; nodular sclerosis is the commonest subtype in young adults, and PD-L1 amplification at 9p24.1 is near universal. Stage I and II disease is divided into favourable and unfavourable groups by the presence of bulky disease, raised erythrocyte sedimentation rate, B symptoms, three or more nodal sites or extranodal extension, definitions that differ slightly between the German Hodgkin Study Group (GHSG) and the EORTC. Radiotherapy alone cured most patients with early disease from the 1960s, but the second cancers and heart disease it caused decades later drove the shift to combined chemotherapy with smaller radiation fields and lower doses.
GHSG HD10 (New England Journal of Medicine 2010) showed that two cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) with 20 Gy of involved-field radiotherapy was enough for favourable disease, and HD11 and HD14 defined four cycles of chemotherapy (or two escalated BEACOPP plus two ABVD) with 30 Gy for unfavourable disease. Interim PET then became the tool for de-escalation: the RAPID trial (New England Journal of Medicine 2015) and EORTC H10 showed that omitting radiotherapy in patients who were PET-negative after two or three ABVD cycles costs a few percentage points of progression-free survival without a survival difference, and HD16 and HD17 refined which PET-negative patients can safely skip radiotherapy, so today many patients receive chemotherapy alone and the rest involved-site radiotherapy with modern conformal or proton techniques that spare the heart and breasts. Brentuximab vedotin and PD-1 antibodies, established in advanced disease, are moving into early-stage trials: the Children's Oncology Group AHOD2131 trial compares brentuximab vedotin with nivolumab against standard chemotherapy in early-stage high-risk disease in patients from age 5 to 60, and the GHSG HD21 and NIVAHL programmes test PD-1 antibodies with reduced chemotherapy. Fertility preservation, cardiac protection and lifelong survivorship care, including breast screening for women irradiated young, are part of standard management.
State of the art
- Cure rates above 90 percent make treatment reduction, not intensification, the aim.
- Interim PET lets many patients avoid radiotherapy altogether.
- Brentuximab vedotin and PD-1 antibodies are entering early-stage trials to replace parts of chemotherapy.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Emergency services nowSkin reaction
Blisters, peeling, or sores in the mouth or eyes with a rash. Enfortumab vedotin carries a boxed warning for Stevens-Johnson syndrome and toxic epidermal necrolysis, mostly in the first cycle.
- Check before combiningFood and drink: Doxorubicin
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
- Check before combiningLiver: Doxorubicin
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
- Good to knowCardiotoxicity (LVEF decline, cardiomyopathy)
Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm. Heart function (LVEF) is monitored by ultrasound during treatment.
See all on the product pages:Brentuximab vedotinDacarbazineDoxorubicinNivolumabVinblastine·Printable cards in the navigator
Anatomy and lymph node drainage
- Bone marrow (leukaemia, MDS, MPN, myeloma)
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- Nodes: cervical
- Nodes: axillary
- Nodes: mediastinal
- Nodes: para-aortic and mesenteric
- Nodes: inguinal
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
- Bone marrow (leukaemia, MDS, MPN, myeloma)
- Lymph node germinal centre (lymphomas)Early favourable classical Hodgkin lymphoma (stage I to II without risk factors; two ABVD and 20 Gy or PET-guided chemotherapy alone) · Early unfavourable classical Hodgkin lymphoma (bulk, raised ESR, three or more sites or extranodal extension) · Nodular sclerosis classical Hodgkin lymphoma (commonest in young adults, mediastinal) · Mixed cellularity classical Hodgkin lymphoma (EBV-positive, children and older adults) · Lymphocyte-rich classical Hodgkin lymphoma · Paediatric and adolescent early-stage classical Hodgkin lymphoma (Children's Oncology Group risk groups)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sitesEarly unfavourable classical Hodgkin lymphoma (bulk, raised ESR, three or more sites or extranodal extension)
- cervical
- axillary
- mediastinal
- para-aortic and mesenteric
- inguinal
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
About half of classical Hodgkin lymphoma, typically in young adults with painless neck or mediastinal nodes; cure rates exceed nine in ten, so the modern problem is avoiding late harm from treatment.
- Mammography & tomosynthesisStandard of care
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
FDG-PET/CT with Lugano staging; bone marrow biopsy no longer needed when PET is used; fertility counselling and cardiac baseline.
Two cycles of ABVD with 20 Gy involved-site radiotherapy (HD10); or PET-adapted chemotherapy alone (three ABVD if PET-negative after two, RAPID and H10) accepting a small increase in relapse.
Four cycles of ABVD (or two escalated BEACOPP plus two ABVD) with 30 Gy involved-site radiotherapy; radiotherapy omitted in PET-negative patients after HD17.
Response-adapted Children's Oncology Group regimens with radiotherapy for slow responders; AHOD2131 tests brentuximab vedotin with nivolumab.
Cardiac surveillance, breast screening from eight years after chest radiotherapy in women, thyroid checks and second-cancer awareness for life.
Subtypes & biomarkers
top- Early favourable classical Hodgkin lymphoma (stage I to II without risk factors; two ABVD and 20 Gy or PET-guided chemotherapy alone)
- Early unfavourable classical Hodgkin lymphoma (bulk, raised ESR, three or more sites or extranodal extension)
- Nodular sclerosis classical Hodgkin lymphoma (commonest in young adults, mediastinal)
- Mixed cellularity classical Hodgkin lymphoma (EBV-positive, children and older adults)
- Lymphocyte-rich classical Hodgkin lymphoma
- Paediatric and adolescent early-stage classical Hodgkin lymphoma (Children's Oncology Group risk groups)
- Interim FDG-PET after two cycles (Deauville score; guides omission of radiotherapy)
- CD30 and CD15 on Hodgkin and Reed-Sternberg cells; CD20 usually negative
- Bulky disease, erythrocyte sedimentation rate, B symptoms and number of sites (GHSG and EORTC risk factors)
- EBV status (EBER) in mixed cellularity disease
- Baseline metabolic tumour volume (prognostic, research)
- Circulating tumour DNA (research; PhasED-seq)
How often this target appears
- 1832Thomas Hodgkin describes the disease
- 1962Kaplan's extended-field radiotherapy cures early-stage disease at Stanford
- 1975Bonadonna introduces ABVD in Milan
- 2010GHSG HD10: two ABVD and 20 Gy suffice for early favourable disease
- 2015RAPID: PET-negative patients can omit radiotherapy at a small cost in relapse
- 2021HD17: radiotherapy omitted in PET-negative early unfavourable disease
- 2022AHOD2131 opens: brentuximab vedotin and nivolumab in early-stage high-risk disease from age 5
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 8 changes by month →- 2026-09-18This recordEarly-stage classical Hodgkin lymphoma (stage I to II)Facts on this page last checked
When this page itself was last checked or edited.
- 2022MilestoneAHOD2131 (COG / NCTN)AHOD2131 opens: brentuximab vedotin and nivolumab in early-stage high-risk disease from age 5
A milestone in how this cancer is treated.
- 2021MilestonePET-adapted (response-adapted) therapyHD17: radiotherapy omitted in PET-negative early unfavourable disease
A milestone in how this cancer is treated.
- 2015MilestonePET-adapted (response-adapted) therapyRAPID: PET-negative patients can omit radiotherapy at a small cost in relapse
A milestone in how this cancer is treated.
- 2010MilestoneABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)GHSG HD10: two ABVD and 20 Gy suffice for early favourable disease
A milestone in how this cancer is treated.
- 1975MilestoneABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)Bonadonna introduces ABVD in Milan
A milestone in how this cancer is treated.
What is in development for Early-stage classical Hodgkin lymphoma (stage I to II), drawn from the whole corpus: 3 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Technologies being tested · 1
Trials under way · 2
- AHOD2131 (COG / NCTN) · phase 3 · Children's Oncology Group / NCI
- Safety and Efficacy of Pembrolizumab (MK-3475) in Children and Young Adults With Classical Hodgkin Lymphoma (MK-3475-667/KEYNOTE-667) · phase 2 · Merck Sharp & Dohme LLC
Open problems and what is being done
Radiotherapy omission trades a few percent more relapses against late harms that take decades to appear.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable nowNothing recorded yet.
In trialsIdeas and roadmapsNothing recorded yet.
Also on OnCo: Treatment journeys · Survivorship planner.
Bleomycin lung toxicity and doxorubicin cardiotoxicity persist even in short regimens.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- Cardio-oncologyEstablished
- IMRT / IGRT (modern external beam)Standard of care
- Proton therapyEstablished
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Side effects by symptom · Immune-related side effects · Toxicity compare · Survivorship planner.
Whether PD-1 antibodies can replace chemotherapy in early disease is untested.
Older patients with early disease tolerate ABVD poorly and have no dedicated standard.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Monrovia, CA · consortium | United States | none recorded | 1 | 20 | 186 | none recorded | - |
Bethesda, MD · government | United States | none recorded | 0 | 2,905 | 47,715 | - | |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Naples · cancer center | Italy | none recorded | 0 | 961 | 15,028 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
Oakland, CA · research institute | United States | none recorded | 0 | 908 | 10,296 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - | |
Philadelphia, PA · hospital | United States | none recorded | 0 | 695 | 9,931 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Memphis, TN · cancer center | United States | 0 | 636 | 8,887 | - | ||
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Early-stage classical Hodgkin lymphoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Early-stage classical Hodgkin lymphoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Interim FDG-PET after two cycles, CD30 and CD15 on Hodgkin and Reed-Sternberg cells; CD20 usually negative, Bulky disease, erythrocyte sedimentation rate, B symptoms and number of sites, EBV statusin mixed cellularity disease, Baseline metabolic tumour volume), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Early favourable classical Hodgkin lymphoma, Early unfavourable classical Hodgkin lymphoma, Nodular sclerosis classical Hodgkin lymphoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Staging
- For my situation (staging), which of the standard options do you recommend and why?Why: Guideline options include: FDG-PET/CT with Lugano staging; bone marrow biopsy no longer needed when PET is used; fertility counselling and cardiac baseline.
Early favourable disease
- For my situation (early favourable disease), which of the standard options do you recommend and why?Why: Guideline options include: Two cycles of ABVD with 20 Gy involved-site radiotherapy (HD10); or PET-adapted chemotherapy alone (three ABVD if PET-negative after two, RAPID and H10) accepting a small increase in relapse.
- Am I a candidate for Doxorubicin, Vinblastine, Dacarbazine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Early unfavourable disease
- For my situation (early unfavourable disease), which of the standard options do you recommend and why?Why: Guideline options include: Four cycles of ABVD (or two escalated BEACOPP plus two ABVD) with 30 Gy involved-site radiotherapy; radiotherapy omitted in PET-negative patients after HD17.
- Am I a candidate for Doxorubicin, Vinblastine, Dacarbazine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Children and adolescents
- For my situation (children and adolescents), which of the standard options do you recommend and why?Why: Guideline options include: Response-adapted Children's Oncology Group regimens with radiotherapy for slow responders; AHOD2131 tests brentuximab vedotin with nivolumab.
- Am I a candidate for Brentuximab vedotin, Nivolumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of AHOD2131 (COG / NCTN) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Survivorship
- For my situation (survivorship), which of the standard options do you recommend and why?Why: Guideline options include: Cardiac surveillance, breast screening from eight years after chest radiotherapy in women, thyroid checks and second-cancer awareness for life.
Any stage
- Are there clinical trials I could join, for example of AHOD2131 (COG / NCTN), Safety and Efficacy of Pembrolizumab (MK-3475) in Children and Young Adults With Classical Hodgkin Lymphoma (MK-3475-667/KEYNOTE-667), PET-adapted (response-adapted) therapy, Brentuximab vedotin?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Radiotherapy omission trades a few percent more relapses against late harms that take decades to appear”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Bleomycin lung toxicity and doxorubicin cardiotoxicity persist even in short regimens”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Early-stage classical Hodgkin lymphoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
11targets
2drugs
6companies
5institutions
1terms
5trials
2key papers
3ECHELON-1 made a targeted antibody-drug conjugate part of first-line Hodgkin therapy and eventually showed that this saves lives, not just relapses. It set the reference arm against which nivolumab-AVD (SWOG S1826) and BrECADD (HD21) were later compared. Neuropathy is the main price and needs proactive dose modification.
PET-negative early Hodgkin lymphoma can be treated with chemotherapy alone at a small cost in relapse, an option many younger patients take to avoid radiation to the chest and neck.
Patients with early favourable Hodgkin lymphoma are cured with two cycles of ABVD and 20 Gy of involved-site radiotherapy; later trials tested whether PET can spare radiotherapy altogether.
Latest papers
topQuery for this cancer: (TITLE:"Early-stage classical Hodgkin lymphoma" OR ABSTRACT:"Early-stage classical Hodgkin lymphoma" OR TITLE:"stage I to II" OR ABSTRACT:"stage I to II" OR TITLE:"Limited-stage Hodgkin lymphoma" OR ABSTRACT:"Limited-stage Hodgkin lymphoma" OR TITLE:"Stage I to II classical Hodgkin lymphoma" OR ABSTRACT:"Stage I to II classical Hodgkin lymphoma" OR TITLE:"Early favourable and early unfavourable Hodgkin lymphoma" OR ABSTRACT:"Early favourable and early unfavourable Hodgkin lymphoma" OR TITLE:"Localised Hodgkin lymphoma" OR ABSTRACT:"Localised Hodgkin lymphoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Early-stage classical Hodgkin lymphoma (stage I to II), not a curated reading list.
Similar pages
not linked directly; found by shared links- CancerRosai-Dorfman-Destombes disease
Shares FDG PET, IMRT / IGRT (modern external beam) and the tags subtype-page, haematologic.
- CancerErdheim-Chester disease
Shares FDG PET and the tags subtype-page, haematologic.
- CancerAdvanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia)
Shares the tags subtype-page, haematologic.
- CancerIndolent and smouldering systemic mastocytosis
Shares the tags subtype-page, haematologic.
- CancerPhyllodes tumour of the breast
Shares Mammography & tomosynthesis, Doxorubicin, IMRT / IGRT (modern external beam) and the tag subtype-page.
- CancerInflammatory breast cancer
Shares Mammography & tomosynthesis, Doxorubicin, IMRT / IGRT (modern external beam), Pembrolizumab and the tag subtype-page.
- CancerPeripheral T-cell lymphomas (including cutaneous T-cell lymphoma)
Shares Lugano classification / Ann Arbor staging, CD30, Brentuximab vedotin, Doxorubicin and the tag haematologic.
- CancerRetroperitoneal sarcoma
Shares Dacarbazine, Doxorubicin, IMRT / IGRT (modern external beam) and the tag subtype-page.