Hodgkin lymphoma: lines of therapy

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9 standard-of-care settings across 6 lines and 2 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
Early / localised	1	·
Locally advanced	1	·
Advanced, first line	3	·
Second line	2	·
Special situations	1	·
Other settings	·	1

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Early stage, favourable (I-II)	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.	DoxorubicinPET-adapted (response-adapted) therapyIMRT / IGRT (modern external beam)Deauville five-point scaleAHOD2131 (COG / NCTN)	NCCN · Category 1 (ABVD × 2 + ISRT 20 Gy or PET-ad…	91

Locally advanced

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Early stage, unfavourable (I-II bulky or risk factors)	ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.	DoxorubicinPET-adapted (response-adapted) therapyIMRT / IGRT (modern external beam)	NCCN · Category 2A	91

Advanced, first line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Advanced stage	Nivolumab-AVD (2026) or BV-AVD; PET-adapted.	NivolumabBrentuximab vedotinFDG PET	NCCN Guidelines: Hodgkin Lymphoma	86
All comers	Advanced stage (III-IV), age ≤60	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.	SWOG S1826NivolumabECHELON-1Brentuximab vedotinGHSG HD21RATHLPD-1 blockade + AVD chemotherapy	NCCN · Category 1 (nivolumab-AVD preferred; BV-AVD)ESMO-MCBS · A (ECHELON-1)	89
All comers	Advanced stage, age >60	Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.	SWOG S1826NivolumabBrentuximab vedotinCaution: bleomycin lung toxicity, especially with brentuximab or G-CSF		89

Second line

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	First relapse, transplant-eligible	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.	Autologous stem cell transplant (high-dose therapy)Brentuximab vedotinNivolumabPembrolizumabAETHERA	NCCN · Category 1 (ASCT after chemosensitive salva…	98
All comers	Relapse after transplant or transplant-ineligible	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.	PembrolizumabKEYNOTE-204NivolumabCheckMate 205Brentuximab vedotinCD30 CAR-T for multiply relapsed Hodgkin lymphoma	NCCN · Category 1 (pembrolizumab, nivolumab, brent…	98

Special situations

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	Survivorship	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.	Cardio-oncologyMammography & tomosynthesis		79

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
Age group	Paediatric (COG / EuroNet)	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.	Brentuximab vedotinPET-adapted (response-adapted) therapyChildren's Oncology Group (COG)		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.

CautionApproved

Caution: cumulative anthracycline dose and the heart

Every dose of doxorubicin adds to a lifetime total; above roughly 450 mg/m2 heart failure risk rises steeply, so sarcoma and lymphoma regimens are capped and hearts are monitored.

Regimens in the library

ABVD BV-AVD N-AVD (nivolumab + AVD)

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.