Guidelines for the first line management of classical Hodgkin lymphoma

Abstract

The guideline group was selected to be representative of UK-based medical experts and patients' representatives. MEDLINE and EMBASE were searched systematically for publications in English from January 1990 to June 2013 using the key words Hodgkin, Lymphoma, Treatment, Chemotherapy and Radiotherapy. References from relevant publications were also searched. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemato-Oncology Task Force of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of approximately 50 UK haematologists and the BCSH and comments incorporated where appropriate. The 'GRADE' system was used to quote levels and grades of evidence, details of which can be found in Appendix I. The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with classical Hodgkin Lymphoma (HL). The guidance may not be appropriate for all patients with HL and in all cases individual patient circumstances may dictate an alternative approach.

Mediastinal Gray Zone Lymphoma with Features Intermediate between Classical Hodgkin Lymphoma and Primary Mediastinal B-Cell Lymphoma

“…The 5-year progression-free survival (PFS) and overall survival (OS) are 73-78% and 82-90%, respectively [3]. Moreover, the R-CHOP (rituximab + cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) and R-CHOEP (R-CHOP + etoposide) regimens have been established as standard treatments for patients with PMBCL [4].…”

Hounsfield units from unenhanced 18F-FDG-PET/CT are useful in evaluating supradiaphragmatic lymph nodes in children and adolescents with classical Hodgkin’s lymphoma

“…For radiological protection, it is preferable to perform magnetic resonance imaging (MRI) and 18F-FDG-PET/MRI; however, CT remains the gold standard for imaging the chest and lungs. Another advantage of using the CT component is that administering iodine contrast agents is unnecessary, unlike with classic CT. 29 The administration of a contrast agent can cause many adverse effects and increases the radiation dosage in the child. [30][31][32] The use of unenhanced CT examination eliminates the risk of tissue size and density measurement errors due to beam hardening artifacts resulting from large residual amounts of concentrated contrast in the blood vessels.…”

Value of18F-FDG PET and PET/CT for Evaluation of Pediatric Malignancies

“…For example, patients with low-risk HL and negative 18 F-FDG PET results at the end of therapy do not require further imaging unless relapse is clinically suspected (61)(62)(63). Current guidelines for HL do not recommend routine follow-up 18 F-FDG PET scans for HL patients (64,65). Tables 3 and 4 provide information about sensitivity, specificity, and accuracy of 18 F-FDG PET or PET/CT, as well as conventional imaging modalities, for staging or therapy response assessment of malignant lymphomas.…”