Hodgkin lymphoma—how much therapy do we need?

Over the past few decades, cure rates for Hodgkin’s lymphoma (HL) have consistently improved with advances in chemotherapy and radiation treatment. However, these therapies—whilst highly effective—may result in significant long-term toxicity with patients being at an increased risk of secondary malignancies, cardiopulmonary long-term toxicity, lower fertility rates and impaired quality of life. Consequently, efforts have been made to reduce side effects while maintaining good response rates. Various studies have examined the possibility of treatment reduction, either through omitting treatment cycles, substances or the radiotherapy component—usually under positron-emission tomography (PET) guidance. Simultaneously, radiation techniques have consistently evolved over the years, with radiation fields decreasing from mantle field radiation commonly used in the 1960s and 1970s to involved site and involved node radiotherapy practiced today. In this review, we aim to provide an overview of the current therapeutic standards across the Hodgkin lymphoma landscape with a particular focus on therapy de-escalation strategies as well as upcoming treatment options with the inclusion of “novel agents” into the first-line and relapsed/refractory setting. Of note, definition of clinical disease stages and corresponding standard of care treatments described in this article are presented according to the GHSG (German Hodgkin Study Group) standards.