Advanced-stage classical Hodgkin lymphoma (stage III to IV): lines of therapy

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6 standard-of-care settings across 4 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	Age group	FRα
Screening, prevention and diagnosis	1	·	·
Advanced, first line	1	1	·
Special situations	·	·	1
Other settings	1	1	·

Screening, prevention and diagnosis

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Staging and risk	FDG-PET/CT with Lugano staging, International Prognostic Score, fertility counselling and cardiac and pulmonary baselines.	FDG PETLugano classification / Ann Arbor stagingOncofertility and fertility preservationCardio-oncology	NCCN Guidelines: Hodgkin Lymphoma	79

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	First line, intensive European option	BrECADD for four to six cycles guided by interim PET (GHSG HD21), replacing escalated BEACOPP.	GHSG HD21Brentuximab vedotinABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)PET-adapted (response-adapted) therapy	NCCN Guidelines: Hodgkin Lymphoma	83
Age group	First line, adults and adolescents 12 and over	Nivolumab with AVD for six cycles (SWOG S1826, preferred); brentuximab vedotin with AVD (ECHELON-1) as an alternative; PET-adapted ABVD with bleomycin omission after two cycles (RATHL) where antibodies are unavailable.	NivolumabSWOG S1826Brentuximab vedotinECHELON-1DoxorubicinVinblastineDacarbazineRATHLPD-1 blockade + AVD chemotherapyCaution: bleomycin lung toxicity, especially with brentuximab or G-CSF	NCCN Guidelines: Hodgkin Lymphoma	89

Special situations

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
FRα	Older or frail patients	AVD with brentuximab vedotin sequenced before and after, or nivolumab-AVD; avoid bleomycin and BEACOPP.	Brentuximab vedotinNivolumabDoxorubicinCardio-oncology	NCCN Guidelines: Hodgkin Lymphoma	86

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	End of treatment	PET-directed consolidation radiotherapy only for residual PET-positive bulky disease; long-term survivorship follow-up.	FDG PETIMRT / IGRT (modern external beam)Deauville five-point scaleLate effects and survivorship toxicity	NCCN Guidelines: Hodgkin Lymphoma	93
Age group	Children	Response-adapted Children's Oncology Group or EuroNet regimens; brentuximab vedotin with AVD in advanced paediatric disease; radiotherapy for slow responders only.	A Study of Brentuximab Vedotin + Adriamycin, Vinblastine, and Dacarbazine in Pediatric Participants With Advanced Stage Newly Diagnosed Hodgkin LymphomaBrentuximab vedotinChildren's Oncology Group (COG)PET-adapted (response-adapted) therapy	NCCN Guidelines: Hodgkin Lymphoma	83

Sequence and caution pairings

CautionApproved

Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF

Bleomycin scars the lungs; combining it with brentuximab was fatal in early trials, and PET-adapted therapy now lets most patients skip it.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.