Treatment of Primary Ovarian Lymphoma in Classic Hodgkin Lymphoma — Stage IIB with Risk Factors, Stage III or IV
Clinical Scenario
This protocol covers primary ovarian lymphoma presenting as classic Hodgkin lymphoma at high-risk or advanced stages: Stage IIB with risk factors (extranodal disease and/or large mediastinal mass), Stage III, or Stage IV. These presentations require a systemic first-line strategy rather than locoregional management alone.
Treatment Approach (Partial Overview)
For eligible patients, treatment centres on a chemotherapy backbone incorporating antibody-drug conjugate–based or checkpoint inhibitor–based regimens, with the specific choice guided by patient age, fitness, and local agent availability. Interim PET imaging drives response-adaptive decisions mid-treatment. The complete protocol details regimen selection, sequencing, and the role of radiotherapy — none of which are summarised here.
Treatment goal: Deauville score 1–3 (negative) at interim PET
References
DOI: 10.1016/j.annonc.2025.07.014
- First line, stage IIB with risk factors (extranodal disease and/or large mediastinal mass), stage III and IV.
- Fit patients ≤60 years should be treated with two cycles of brentuximab vedotin—etoposide—cyclophosphamide—doxorubicin—dacarbazine—dexamethasone (BrECADD) [I, A; EMA approved, not FDA approved] followed by iPET [I, A].
- Six cycles of nivolumab (Nivo)-AVD represents an alternative treatment option for patients ≤60 years and is considered the favoured option for patients 60–80 years [I, A; not EMA or FDA approved].
- If BV and programmed cell death protein 1 (PD-1) inhibitors are not available, standard treatment options are ABVD [I, A] or escalated bleomycin—etoposide—doxorubicin—cyclophosphamide—vincristine—prednisone—dacarbazine (eBEACOPDac) [IV, B], depending on tolerability.
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