‘The HemOnc Pulse’ Live 2024: How Is Hodgkin Lymphoma Treated?

Recorded at the first “HemOnc Pulse” Live meeting, this podcast episode features a panel discussion on unanswered questions in Hodgkin lymphoma with Andrew Evens, DO, MBA, MSc, Director of the Lymphoma Program and Associate Director of Rutgers Cancer Institute; Grzegorz Nowakowski, MD, a Professor of Oncology and Medicine in Division of Hematology at the Mayo Clinic; and Jane Winter, MD, a Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine.

The panel mainly discussed treatment options for Hodgkin lymphoma.

“I’m still giving BV-AVD for advanced stage Hodgkin lymphoma, but I look for any reason not to,” said Dr. Evens. “For older patients and those with pre-existing neuropathy, I’ve been giving nivolumab-AVD.”

Dr. Winter and colleagues studied pembrolizumab in untreated, early, unfavorable, and advanced stage Hodgkin Lymphoma. One-third of patients achieved complete remission (CR) after three doses, while another third achieved more than 90% reduction in total metabolic volume. After an additional two cycles of AVD, all patients achieved CR.

A follow-up, investigator-initiated, international trial is evaluating six doses of pembrolizumab upfront. “By giving six doses, we hope to push the majority of patients into CR, then administer abbreviated chemotherapy,” Dr. Winter said. “We’re hoping to reduce the amount of chemotherapy.”

Next, the panel addressed relapsed disease and approaches to maintenance therapy following autologous hematopoietic stem cell transplantation.

“For patients who truly had the disease progressive for BV-AVD, I may not give [bevacizumab] after,” Dr. Nowakowski said. “With the data we have, I use maintenance with BV after transplant. A significant proportion of those patients would relapse after transplant. That has been associated with the benefit.”

“I tend to use pembrolizumab-GVD, because pembrolizumab-ICE is much more toxic in patients,” Dr. Winter added. “Virtually all of our patients are in remission. If they don’t look like they’re in remission, we biopsy them because the pembrolizumab will often give a false abnormality that’s not residual disease.”

Finally, the panel discussed the pros and cons of radiation as primary therapy for early-stage Hodgkin lymphoma. While radiation is associated with increased risk of secondary malignancies such as breast cancer, it is a beneficial treatment option for certain patient populations.

“For patients who fail initial therapy, radiation is very important,” Dr. Winter said.