The first 60 days: Hodgkin lymphoma
Hodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab. Below, week by week, is what OnCo's record of Hodgkin lymphoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- RadiologistNamed in the standard of care for: Advanced stage, Early stage, favourable (I-II), Early stage, unfavourable (I-II bulky or risk factors), Advanced stage (III-IV), age ≤60 and 3 more.
- Medical oncologistNamed in the standard of care for: Advanced stage, Early stage, favourable (I-II), Early stage, unfavourable (I-II bulky or risk factors), Advanced stage (III-IV), age ≤60 and 5 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early stage, favourable (I-II), Early stage, unfavourable (I-II bulky or risk factors), Advanced stage (III-IV), age ≤60, Relapse after transplant or transplant-ineligible and 1 more.
- Transplant and cell therapy teamNamed in the standard of care for: First relapse, transplant-eligible, Relapse after transplant or transplant-ineligible.
- Palliative and supportive care teamNamed in the standard of care for: Early stage, favourable (I-II), Early stage, unfavourable (I-II bulky or risk factors), Relapse after transplant or transplant-ineligible, Survivorship.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Early stage, favourable (I-II)NCCN category Category 1 (ABVD × 2 + ISRT 20 Gy or PET-adapted chemotherapy alone), NCCN Hodgkin Lymphoma 2026
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.
ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.
Nivolumab-AVD (2026) or BV-AVD; PET-adapted.
- 4.Advanced stage (III-IV), age ≤60NCCN category Category 1 (nivolumab-AVD preferred; BV-AVD), ESMO-MCBS A (ECHELON-1), NCCN 2026
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.
Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.
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.
- 7.First relapse, transplant-eligibleNCCN category Category 1 (ASCT after chemosensitive salvage; BV consolidation for high risk), NCCN 2026
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.
- 8.Relapse after transplant or transplant-ineligibleNCCN category Category 1 (pembrolizumab, nivolumab, brentuximab), NCCN 2026
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.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?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?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?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?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?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?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?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?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?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of SWOG S1826 apply to someone like me?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of AETHERA apply to someone like me?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?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?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?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
Survivorship
- For my situation (survivorship), which of the standard options do you recommend and 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.
Any stage
- Are there clinical trials I could join, for example of Abexinostat, MK-1045, Cobolimab, Rondecabtagene autoleucel?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?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?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Late toxicity in survivors”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Older patients”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Study to Investigate Ronde-cel Versus Investigator's Choice CD19 CAR T-Cell TherapyPhase 3 · recruiting · NCT07188558A Phase 3 Randomized Controlled Trial of Rondecabtagene Autoleucel, an Autologous, Dual-targeting CD19/CD20 CAR T-Cell Product Candidate, Vs. Investigator's Choice of CD19 CAR T-Cell Therapy in Patients With Relapsed or Refractory Large B-Cell Lymphoma in the Second-line Setting
- A Study to Investigate the Efficacy of Zanubrutinib Plus Rituximab Compared With Bendamustine Plus Rituximab in Adults With Previously Untreated MantlPhase 3 · active · NCT04002297A Phase 3 Randomized, Open-Label, Multicenter Study Comparing Zanubrutinib (BGB-3111) Plus Rituximab Versus Bendamustine Plus Rituximab in Patients With Previously Untreated Mantle Cell Lymphoma Who Are Ineligible for Stem Cell Transplantation
- A Trial to Learn How Effective and Safe Odronextamab is Compared to Standard of Care for Adult Participants With Previously Treated Aggressive B-cell Phase 3 · active · NCT06230224A Phase 3, Randomized, Open Label Study Evaluating the Efficacy and Safety of Odronextamab (REGN1979), an Anti-CD20 x Anti-CD3 Bispecific Antibody, Versus Standard of Care Therapy in Participants With Relapsed/Refractory Aggressive B-cell Non-Hodgkin Lymphoma (OLYMPIA-4)
- AHOD2131 (COG / NCTN)Phase 3 · recruiting · NCT05675410Newly diagnosed stage I-II classical Hodgkin lymphoma, age 5-60: standard therapy vs brentuximab vedotin + nivolumab (response-adapted), with or without radiation
- 9-ING-41 in Patients With Advanced CancersPhase 2 · active · NCT03678883Phase 1/2 Study of 9-ING-41, a Glycogen Synthase Kinase-3 Beta (GSK-3β) Inhibitor, as a Single Agent and Combined With Chemotherapy, in Patients With Refractory Hematologic Malignancies or Solid Tumors
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Hodgkin lymphoma: the full pageHodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens): The chemotherapy recipes that cure most Hodgkin lymphoma: ABVD (four drugs, the long-standing standard), the more intensive German BEACOPP, and newer versions that replace bleomycin with brentuximab vedotin (A+AVD) or add nivolumab (N-AVD).
- Reed-Sternberg cell: The Reed-Sternberg cell is the giant, often two-nucleus cancer cell of Hodgkin lymphoma; it makes up only about 1% of the tumour, and the rest is immune cells it has recruited.
- Overall survival (OS): Overall survival (OS) is how long patients live, full stop.
- Progression-free survival (PFS): Progression-free survival (PFS) is how long patients live without their cancer growing.
- Deauville score and PET-adapted therapy: A 1-to-5 scale for how brightly a lymphoma lights up on a PET scan, compared with the liver and the middle of the chest.
- Deauville five-point scale: A 1-to-5 score for how bright a lymphoma looks on PET compared with the liver; 1-3 is considered a complete metabolic response.
- Second cancers after radiotherapy: Radiotherapy can itself cause a new cancer in the treated area, typically ten to thirty years later.
- Lymphoma (tissue type): Cancer of lymphocytes, the white blood cells of the immune system, usually growing as masses in lymph nodes, spleen or other organs.
- Deep inspiration breath-hold (DIBH): Taking and holding a deep breath during each radiation beam.
- Autologous stem cell transplant (ASCT): High-dose chemotherapy (melphalan in myeloma, BEAM in lymphoma) that would permanently destroy the bone marrow, made survivable by giving the patient back their own previously collected stem cells, which engraft in 10-14 days.
Every term links to the glossary.