Decisions and supportHodgkin lymphoma

Back to the Hodgkin lymphoma hub →35 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

Decisions and support

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Decisions you may face

11 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Advanced stage3 Early stage, favourable (I-II)3 Early stage, unfavourable (I-II bulky or risk factors)3 Advanced stage (III-IV), age ≤602 Advanced stage, age >602 First relapse, transplant-eligible4 Relapse after transplant or transplant-ineligible3 Paediatric (COG / EuroNet)2 Survivorship2 Choosing treatment in Hodgkin lymphoma: stage, risk factors and the interim PET2 Survivorship after Hodgkin lymphoma: what the cure costs, and what is watched for2

Red cards

What to watch for and who to call, from the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Hypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Nivolumab Pembrolizumab source
Emergency services now
Bleeding or bruising
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Doxorubicin source
Emergency services now
Confusion, weakness on one side, or loss of speech or vision
Any new neurological symptom that is not explained. Brentuximab vedotin carries a boxed warning for progressive multifocal leukoencephalopathy, a brain infection; the label says to hold the drug and investigate at the first suspicion.
Brentuximab vedotin source
Call the 24-hour line now
Neutropenic fever
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Brentuximab vedotin source
Call the team today
Numbness or weakness
Tingling, numbness or weakness that affects walking or using the hands; peripheral neuropathy is common with the vedotin (MMAE) payload and doses are reduced or stopped at grade 2 to 3.
Brentuximab vedotin source
Check before combining
Food and drink: Doxorubicin
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Doxorubicin source

See all on the product pages:Brentuximab vedotin Doxorubicin Nivolumab Pembrolizumab·Printable cards in the navigator

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Hodgkin lymphoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 35 questions

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 PET, CD30, PD-L1, Interim PETafter cycle 2, CD30 and CD15 on Reed-Sternberg cells; CD20 in NLPBL), 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 Classical Hodgkin lymphoma: nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted, Nodular lymphocyte-predominant B-cell lymphoma, Early stagefavourable vs unfavourable.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Advanced stage

For my situation (advanced stage), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab-AVD (2026) or BV-AVD; PET-adapted.
Am I a candidate for Nivolumab, Brentuximab vedotin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Early stage, favourable (I-II)

For my situation (early stage, favourable (i-ii)), which of the standard options do you recommend and why?
Why: Guideline options include: ABVD × 2 + involved-site radiotherapy 20 Gy (HD10), or PET-adapted omission of radiotherapy after 3 cycles if PET-negative (RAPID, HD16) accepting ~5% lower PFS; AHOD2131 tests BV-nivo.
Am I a candidate for Doxorubicin, 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.

Early stage, unfavourable (I-II bulky or risk factors)

For my situation (early stage, unfavourable (i-ii bulky or risk factors)), which of the standard options do you recommend and why?
Why: Guideline options include: ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.
Am I a candidate for Doxorubicin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage (III-IV), age ≤60

For my situation (advanced stage (iii-iv), age ≤60), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab-AVD × 6 (S1826; approved March 2026, no routine radiotherapy) or BV-AVD × 6 with G-CSF (ECHELON-1); in Europe PET-guided BrECADD × 4-6 (HD21) or eBEACOPP; PET-adapted ABVD/AVD (RATHL) where novel agents unavailable.
Am I a candidate for Nivolumab, Brentuximab vedotin, 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 SWOG S1826 and ECHELON-1 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Advanced stage, age >60

For my situation (advanced stage, age >60), which of the standard options do you recommend and why?
Why: Guideline options include: Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.
Am I a candidate for Nivolumab, Brentuximab vedotin, 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 SWOG S1826 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

First relapse, transplant-eligible

For my situation (first relapse, transplant-eligible), which of the standard options do you recommend and why?
Why: Guideline options include: Salvage (ICE, DHAP, GVD, BV-nivolumab or pembrolizumab-GVD) → PET-negative → high-dose therapy and autologous transplant; brentuximab consolidation for high-risk (AETHERA); PD-1 maintenance in trials.
Am I a candidate for Brentuximab vedotin, Nivolumab, Pembrolizumab, 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 AETHERA apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Relapse after transplant or transplant-ineligible

For my situation (relapse after transplant or transplant-ineligible), which of the standard options do you recommend and why?
Why: Guideline options include: Pembrolizumab (KEYNOTE-204) or nivolumab; brentuximab vedotin if not yet given; BV + nivolumab; allogeneic transplant for fit patients after response; CD30 CAR-T in trials; palliative radiotherapy or bendamustine.
Am I a candidate for Pembrolizumab, Nivolumab, Brentuximab vedotin, 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 KEYNOTE-204 and CheckMate 205 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Paediatric (COG / EuroNet)

For my situation (paediatric (cog / euronet)), which of the standard options do you recommend and why?
Why: Guideline options include: Risk-adapted OEPA/COPDAC (EuroNet-PHL-C2) or ABVE-PC with brentuximab (AHOD1331, EFS benefit) and PET-guided radiotherapy omission; S1826 and AHOD2131 now enrol from age 12 or 5.
Am I a candidate for Brentuximab vedotin, 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 AHOD1331 and EuroNet-PHL-C2 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: Lifelong surveillance for cardiac disease (anthracycline, mediastinal RT), breast cancer screening from 8 years after chest RT in women, thyroid and lung checks, fertility counselling before therapy.

Choosing treatment in Hodgkin lymphoma: stage, risk factors and the interim PET

For my situation (choosing treatment in hodgkin lymphoma: stage, risk factors and the interim pet), which of the standard options do you recommend and why?
Why: Guideline options include: Three inputs. Stage by PET-CT reported with the Lugano classification. Risk factors, which differ by group: the German Hodgkin Study Group counts a large mediastinal mass, extranodal disease, a raised erythrocyte sedimentation rate and three or more nodal areas; EORTC counts a large mediastinal mass, age 50 or over, a raised sedimentation rate and four or more nodal areas. And the interim PET after two cycles, scored 1 to 5 on the Deauville scale, which is used to intensify treatment in patients who have not responded and to reduce it in those who have. That last step, PET adaptation, is the structural idea behind modern Hodgkin treatment. RATHL showed that bleomycin can be dropped from cycles 3 to 6 in patients whose PET after two cycles is negative, with three-year progression-free survival of 85.7 per cent for continued ABVD against 84.4 per cent for AVD, which removed lung toxicity from most patients' treatment. EORTC H10 showed the reverse direction: in patients whose early PET was positive, switching from ABVD to escalated BEACOPP with involved-node radiotherapy raised five-year progression-free survival from 77.4 to 90.6 per cent (hazard ratio 0.42). Before the first cycle: lung function tests if bleomycin is planned, echocardiography, hepatitis B, hepatitis C and HIV testing, and a fertility conversation, which in a disease of young people is not optional.
How do the results of RATHL apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Survivorship after Hodgkin lymphoma: what the cure costs, and what is watched for

For my situation (survivorship after hodgkin lymphoma: what the cure costs, and what is watched for), which of the standard options do you recommend and why?
Why: Guideline options include: Most people treated for Hodgkin lymphoma are cured and then live for decades with the consequences. Anthracyclines cause cardiomyopathy. Mediastinal radiotherapy causes coronary and valve disease, and, twenty to thirty years later, breast and lung cancer inside the irradiated field; the lung cancer risk multiplies with smoking rather than adding to it. Neck radiotherapy causes hypothyroidism in a large minority. Procarbazine and other alkylators cause infertility and a small excess of myelodysplasia and leukaemia. Bleomycin causes lung fibrosis. The long-term German Hodgkin Study Group series of 471 patients with the nodular lymphocyte-predominant subtype makes the arithmetic plain: ten-year overall survival was 92.1 per cent, second cancers occurred in 10.2 per cent, and of 43 deaths only 10 were from the lymphoma, against 20 from second cancers and 13 from conditions possibly related to treatment. Follow-up therefore includes cardiovascular risk assessment, thyroid function after neck or upper mediastinal radiotherapy, echocardiography at intervals, active smoking cessation support, and, in England, automatic referral into the NHS breast screening programme's very high risk pathway for women who had radiotherapy to breast tissue for Hodgkin or non-Hodgkin lymphoma between the ages of 10 and under 36. All of it is the reason treatment keeps being de-escalated.

Any stage

Are there clinical trials I could join, for example of Abexinostat, MK-1045, Cobolimab, Rondecabtagene autoleucel?
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 “Late toxicity in survivors”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “Older patients”. 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 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.

Cancers·Hodgkin lymphoma