Immunotherapy in Early-Stage Hodgkin Lymphoma — Are We Ready to Move Beyond RT?
One of the most fascinating discussions from the lecture by Prof.Ranjana Advani was how the field is shifting from:
➡️ “Can we cure Hodgkin lymphoma?”
to
➡️ “Can we preserve cure while reducing long-term toxicity?”
For decades, combined modality therapy has remained standard, especially in bulky/unfavourable disease. But mediastinal RT carries important long-term risks:
⚠️ secondary malignancies
⚠️ cardiovascular toxicity
⚠️ pulmonary toxicity
⚠️ breast cancer risk in younger patients
This has driven intense interest in immunotherapy-based frontline strategies:
🔹 BV + chemotherapy
🔹 CPI + chemotherapy
🔹 BV + CPI + chemotherapy
Key studies like:
📚 Kumar et al (BV-AVD PET-adapted strategy)
📚 NIVAHL
📚 AN+AD
have shown remarkably high PET-negativity and PFS rates, raising the possibility of selective RT reduction in carefully chosen patients.
But are we truly ready to omit RT routinely?
Probably not yet.
Most studies remain phase II with limited long-term follow-up, and bulky mediastinal disease continues to be the most difficult setting for RT omission.
Another evolving challenge:
🧠 PET interpretation after checkpoint inhibitors may differ because of inflammatory uptake and pseudo-progression.
Current direction of the field:
✅ PET-adapted RT minimization
❌ Routine RT elimination in bulky disease
link to the lecture youtube.com/live/HYX3kt2a_…
#HodgkinLymphoma #Lymphoma #Immunotherapy #Hematology #Oncology #MedTw
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