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39

NCCN Guidelines for Patients

®

Hodgkin Lymphoma, Version 1.2015

4

Treatment guide: Classical Hodgkin lymphoma Stages I and II treatment

Part 4.1 has three sections:

Easier-to-treat cancers

,

Small harder-to-treat cancers

, and

Large harder-

to-treat cancers

. If harder to treat, more intense

treatment is used to try to cure the cancer. Many

of these cancers can be cured. It is harder to treat

Hodgkin lymphoma when:

• The cancer is large (“bulky”),

• There are B symptoms (fevers, night sweats,

weight loss),

• ESR is 50 or higher, or

• There are 4 or more sites with cancer.

There are two types of bulky cancers. The first

type occurs between the lungs and has an MMR

(

m

ediastinal

m

ass

r

atio) greater than 0.33. The

second group is large tumors in lymph nodes. These

tumors are large when they are 10 cm or greater in

width.

Chart 4.1.1

maps one of the treatment paths for

stage I or II that is easier to treat. Chemotherapy with

radiation therapy is the preferred treatment choice.

Treatment begins with chemotherapy.

ABVD or Stanford V regimens can be used. Stanford

V should be given for 8 weeks. ABVD can be given

for either 4 or 2 cycles. Two cycles are used for

cancers that are very easy to treat. These cancers

haven’t spread beyond the lymph nodes, are in

fewer than 3 sites, produce an ESR lower than 30, or

produce an ESR lower than 50 and haven’t caused B

symptoms.

After chemotherapy, cancer sites can be treated with

radiation if tests suggest that treatment is working.

If tests suggest that treatment is working poorly, a

biopsy is needed. If no cancer is found, you can

receive radiation therapy. If cancer is found, read Part

4.3 to learn which treatments you can receive next.

Chart 4.1.2

maps a second treatment path for

stage I or II that is easier to treat. The goal is to use

chemotherapy only. At first, 2 cycles of ABVD should

be given. Then, tests to assess treatment results

should be received. If there are no signs of cancer,

you can receive 2 more cycles of ABVD. If there are

signs of cancer, 4 cycles are needed.

After chemotherapy, treatment results should be

tested. If chemotherapy appears to be working

well, you can start follow-up care. Read Part 4.5 for

more information. If chemotherapy appears to be

working less well, the cancer sites can be treated with

radiation.

When treatment results appear to be poor, a biopsy

is needed. If no cancer is found, you can receive

radiation therapy. If cancer is found, read Part 4.3 to

learn which treatments you can receive next.

Chart 4.1.3

maps a third treatment path for stage

I or II that is easier to treat. The goal is to use

chemotherapy only. Treatment consists of 3 cycles of

ABVD.

After chemotherapy, treatment results should be

tested. If chemotherapy appears to be working well,

you can start follow-up care. Read Part 4.5 for more

information. If chemotherapy appears to be working

less well, you can receive one more cycle of ABVD

with radiation therapy.

When treatment results appear to be poor, a biopsy

is needed. If no cancer is found, you can receive

radiation therapy. If cancer is found, read Part 4.3 to

learn which treatments you can receive next.