Classic Hodgkin Lymphoma Stage IIB–IV (Primary Ovarian Lymphoma): Protocol After First-Line Treatment Failure

This protocol covers patients with primary ovarian lymphoma presenting as classic Hodgkin lymphoma — specifically stage IIB with risk factors (extranodal disease and/or large mediastinal mass), stage III, or stage IV — whose disease has relapsed or become refractory after first-line therapy.

Clinical Scenario

Classic Hodgkin lymphoma, stage IIB with risk factors (extranodal disease and/or large mediastinal mass), stage III or IV. This is an advanced-stage presentation with features that define a high-risk first-line population.

First-Line Treatment Did Not Achieve Its Target

First-line regimens — which may include BrECADD, nivolumab-AVD, BV-AVD, ABVD, or eBEACOPDac — aim for a Deauville score of 1–3 (PET-negative) at interim PET. When this response target is not met, or when the disease subsequently relapses or becomes refractory, the treatment strategy must escalate to the next line.

Next-Line Approach (Partial Overview)

Relapsed or refractory disease is managed with a salvage chemotherapy strategy aimed at consolidation with autologous stem cell transplantation (ASCT) in eligible patients. Integration of novel targeted agents alongside salvage chemotherapy may be appropriate. Distinct options are defined for patients who are ineligible for ASCT or who relapse following it.

The complete regimen, agent selection, sequencing criteria, and eligibility considerations are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

First line, stage IIB with risk factors (extranodal disease and/or large mediastinal mass), stage III and IV:

Patients should receive salvage ChT followed by ASCT [I, A].

The following salvage ChT options can be recommended [III, B]: DHAP, ESHAP, GDP, ICE, BEGEV or GVD.

BV maintenance therapy in BV-naive patients with high-risk features after ASCT can be considered [I, B].

In patients unsuitable for or relapsing after ASCT who are PD-1 inhibitor- and BV-naive, pembrolizumab is favoured over BV [I, A].

AlloSCT can be considered in suitable patients after ASCT [III, B].

DOI: 10.1016/j.annonc.2025.07.014

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