Published online 10 March 2009
Haematologica, Vol 94, Issue 4, 550-565 doi:10.3324/haematol.2008.002451
Copyright © 2009 by Ferrata Storti Foundation

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Hodgkin's Lymphoma

Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

Ercole Brusamolino¹, Andrea Bacigalupo², Giovanni Barosi³, Giampaolo Biti⁴, Paolo G. Gobbi⁵, Alessandro Levis⁶, Monia Marchetti, Armando Santoro⁸, Pier Luigi Zinzani⁹, Sante Tura⁹

¹ Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Pavia
² Divisione di Ematologia e Trapianto di Midollo Osseo, Ospedale San Martino, Genova
³ Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia
⁴ Radioterapia, Ospedale di Careggi, Università di Firenze
⁵ Medicina Interna, GastroEnterologia e Oncologia Medica, Fondazione IRCCS San Matteo, Pavia
⁶ Divisione di Ematologia, Ospedale SS Antonio e Biagio, Alessandria
⁷ Medicina A, Ospedale Cardinale Massaia, Asti
⁸ Dipartimento di Oncologia Medica ed Ematologia, Istituto Clinico Humanitas, Rozzano
⁹ Istituto di Ematologia e Oncologia Medica "L. e A. Seràgnoli", Università di Bologna, Italy

Correspondence: Ercole Brusamolino, M.D., Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia 27100, Italy. E-mail:ebrusa{at}smatteo.pv.it

The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin’s lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin’s lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high-dose chemotherapy and autologous hemopoietic stem cells transplant. Allogeneic transplant is recommended in patients relapsing after autologous transplant. All fertile patients should be informed of the possible effects of therapy on gonadal function and fertility preservation measures should be taken before the initiation of therapy.

Key words: Hodgkin’s lymphoma, clinical guidelines.

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