Symposium | Panel discussion | How to sequence targeted therapies in classic Hodgkin lymphoma

During the European School of Haematalogy (ESH) 4th How to Diagnose and Treat Lymphoma Conference, the Lymphoma Hub held a symposium on November 02, 2024 titled Treating classic Hodgkin lymphoma (cHL): Spotlight on targeted therapies. Gilles Salles, Memorial Sloan Kettering Cancer Center, New York, US, chaired a panel discussion on sequencing targeted therapies in cHL.

Salles provides an overview of the treatment recommendations for cHL by the National Comprehensive Cancer Network (NCCN) 2024 and European Society for Medical Oncology (ESMO) 2018 guidelines:^1,2

• In limited and intermediate-stage disease, treatment usually consists of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and/or escalated-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (eBEACOPP).
• In relapsed disease, treatment usually consists of high-dose chemotherapy (HDCT) and autologous stem cell transplant (auto SCT).
• In high-risk patients with relapse, brentuximab vedotin after HDCT/auto SCT can improve tumor control when patients have primary disease progression, early disease recurrence <12 months after the end of first-line treatment, or extranodal disease at the time of relapse.
• Salvage regimens include dexamethasone + high-dose cytarabine + cisplatin (DHAP), ifosfamide + gemcitabine + vinorelbine (IGEV), ifosfamide + carboplatin + etoposide (ICE), or brentuximab vedotin.

Salles discusses case studies (Figures 1-5) with expert insights on treatment approaches from Ann LaCasce from Harvard Medical School, Boston, US, and  Paul Bröckelmann from University Hospital of Cologne, Cologne, DE. 

Figure 1. Case 1* 

CT, computed tomography; FDG, fluorodeoxyglucose; HL, Hodgkin lymphoma; PET, positron emission tomography; SUV, standardized uptake value. 
*Case provided by Salles G.

Figure 2. Case 2* 

cHL, classic Hodgkin lymphoma.
*Case provided by Salles G.

Figure 3. Case 3*

CT, computed tomography; EBV, Epstein Barr virus; HL, Hodgkin lymphoma; PET, positron emission tomography; SUV, standardized uptake value.
*Case provided by Salles G.
^†B symptoms include fever, drenching night sweats, and loss of >10% of bodyweight over 6 months.

Figure 4. Case 4* 

CAD, coronary artery disease; EF, ejection fraction; HL, Hodgkin lymphoma; HLP, hyperlipoproteinemia; HTN, hypertension.
*Case provided by Salles G.

Figure 5. Case 5* 

ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; ASCT, autologous stem cell transplantation; BEAM, carmustine, etoposide, aracytin, and melphalan; CR, complete response; DHAP, dexamethasone, high-dose cytarabine, and cisplatin; Hgb, hemoglobin; PET, positron emission tomography.
*Case provided by Salles G.

This independent educational activity was supported by Takeda. All content was developed independently by the faculty in collaboration with SES. The funder was allowed no influence on the content of the symposium.