Treatment of Primary Ovarian Lymphoma in Classic Hodgkin Lymphoma, Early-Stage Unfavourable Disease
This protocol covers the first-line management of primary ovarian lymphoma arising in the setting of classic Hodgkin lymphoma (cHL) with early-stage unfavourable characteristics — a distinct sub-population with specific treatment requirements.
Clinical Scenario
Classic Hodgkin lymphoma, early-stage unfavourable: Early-stage unfavourable disease is defined as either stage I or IIA with one or more risk factor (i–iv), or stage IIB with risk factor i and/or ii.
Treatment Approach
Management is age-stratified and involves sequential combination chemotherapy with interim PET-guided response assessment; the specific regimen sequence and the role of radiotherapy depend on patient age and treatment response.
Treatment Goal
The primary clinical objective is a negative interim PET scan.
Target: Deauville score 1–3 at interim PET (negative iPET)
References
DOI: 10.1016/j.annonc.2025.07.014
- Early-stage unfavourable disease defined as either: stage I or IIA with one or more risk factor i-iv or stage IIB with risk factor i and/or ii (see footnote b for risk factors).
- Two cycles of escalated bleomycin—etoposide—doxorubicin—cyclophosphamide—vincristine—procarbazine—prednisone (eBEACOPP) [I, A] followed by two cycles of ABVD [I, A] and then iPET [I, A].
- If the DS is 4-5 at iPET, patients should receive 30 Gy ISRT [I, A].
- If the DS is 1-3 at iPET, no further treatment is required [I, A].
- Four cycles of ABVD [I, A] followed by 30 Gy ISRT [I, A].
- Patients >60 years of age with unfavourable cHL should be treated with two cycles of ABVD [I, A] followed by two cycles of doxorubicin—vinblastine—dacarbazine (AVD) [I, A] and then 30 Gy ISRT [I, A].
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