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Hodgkin lymphoma

Hodgkin lymphoma is one of the most curable cancers, where the goal is now to cure with less toxicity, using brentuximab and, from 2026, first-line nivolumab.

Classical Hodgkin lymphoma is a B-cell cancer in which rare, giant Reed-Sternberg cells (about 1% of the mass) recruit an inflammatory microenvironment and hide behind amplified PD-L1. It peaks in young adults and again after 55, is staged with PET-CT and the Lugano system, and is cured in more than 85% of patients overall and in over 90% of early-stage disease. Because most patients are young and will live for decades, the field's defining problem is not cure but the cost of cure: anthracycline heart disease, bleomycin lung injury, infertility, and second cancers from alkylators and radiation.

That is why Hodgkin lymphoma pioneered response-adapted therapy. Interim PET after two cycles (Deauville score) steers de-escalation (drop bleomycin after negative PET2 in RATHL; omit radiotherapy in early stage in HD16/HD17/RAPID at a small PFS cost) or escalation to BEACOPP-type regimens. Two ADC- and immunotherapy-based regimens then replaced ABVD for advanced disease: brentuximab vedotin-AVD (ECHELON-1, overall survival benefit) and, from March 2026, nivolumab-AVD (SWOG S1826, PFS HR 0.45 versus BV-AVD, neuropathy halved, children and adults together). In Europe, GHSG HD21's PET-guided BrECADD matches escalated BEACOPP's ~94% PFS with far less toxicity. Relapse is treated with PD-1 blockade (pembrolizumab beat brentuximab in KEYNOTE-204), brentuximab, salvage chemotherapy and autologous transplant, with brentuximab consolidation for high-risk patients (AETHERA); allogeneic transplant and CD30 CAR-T are options for the few who fail everything.

The next questions are how far chemotherapy can be removed. AHOD2131 tests brentuximab-nivolumab in early-stage disease across children and adults; ctDNA may replace PET for steering; older patients, who have half the cure rate of young ones, need regimens they can tolerate (nivolumab-AVD, brentuximab-based). Survivorship care for the tens of thousands cured decades ago, and the shift from radiotherapy to systemic de-escalation, remain the field's distinctive concerns.

State of the art today

  • Immunotherapy in first line with less toxicity.
  • Interim PET steers therapy for nearly every patient: bleomycin omission (RATHL), radiotherapy omission (HD16/17, RAPID), cycle number (HD18, HD21).
  • Radiotherapy is disappearing from advanced-stage care (<1% in S1826) and being minimised in early stage.
  • PD-1 blockade is the most effective single agent in any lymphoma relapse (ORR ~70%), and beat brentuximab head to head (KEYNOTE-204).
  • Cure rates above 90% in young patients shift the research agenda to late effects and to older adults.
Show survival figures (2)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • Nivolumab-AVD is the new frontline standard for advanced disease (S1826: 2-year PFS 92%, neuropathy halved), approved March 2026 for ages 12 and up.
  • Two intensive but de-toxified European options: PET-guided BrECADD (HD21) achieves ~94% 5-year PFS with 40% less morbidity than eBEACOPP.
Who it affects
Show survival figures (1)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • ~83,000 new cases and ~23,000 deaths a year worldwide; ~8,500 US cases; bimodal age peaks (20-30 and >55); five-year survival ~89% overall in high-income countries.

Where the cases are

Cases by country · GLOBOCAN 2022
All countries →

Site: Hodgkin lymphoma. World: 82,469 new cases, 22,733 deaths.

#CountryNew casesDeaths
1India9,6113,522
2United States of America8,536929
3China4,3631,931
4Russian Federation3,015774
5Brazil2,667640
6Germany2,419330
7Mexico2,341659
8United Kingdom2,270310
9Italy2,190425
10Nigeria1,989920

Standard of care

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Advanced stage

Nivolumab-AVD (2026) or BV-AVD; PET-adapted.

Early stage, favourable (I-II)

ABVD × 2 + involved-site radiotherapy 20 Gy (HD10), or PET-adapted omission of radiotherapy after 3 cycles if PET-negative (RAPID, HD16) accepting ~5% lower PFS; AHOD2131 tests BV-nivo.

NCCN · Category 1 (ABVD × 2 + ISRT 20 Gy or PET-ad…
Early stage, unfavourable (I-II bulky or risk factors)

ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.

NCCN · Category 2A
Advanced stage (III-IV), age ≤60

Nivolumab-AVD × 6 (S1826; approved March 2026, no routine radiotherapy) or BV-AVD × 6 with G-CSF (ECHELON-1); in Europe PET-guided BrECADD × 4-6 (HD21) or eBEACOPP; PET-adapted ABVD/AVD (RATHL) where novel agents unavailable.

NCCN · Category 1 (nivolumab-AVD preferred; BV-AVD)ESMO-MCBS · A (ECHELON-1)
Advanced stage, age >60

Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.

First relapse, transplant-eligible

Salvage (ICE, DHAP, GVD, BV-nivolumab or pembrolizumab-GVD) → PET-negative → high-dose therapy and autologous transplant; brentuximab consolidation for high-risk (AETHERA); PD-1 maintenance in trials.

NCCN · Category 1 (ASCT after chemosensitive salva…
Relapse after transplant or transplant-ineligible

Pembrolizumab (KEYNOTE-204) or nivolumab; brentuximab vedotin if not yet given; BV + nivolumab; allogeneic transplant for fit patients after response; CD30 CAR-T in trials; palliative radiotherapy or bendamustine.

NCCN · Category 1 (pembrolizumab, nivolumab, brent…
Paediatric (COG / EuroNet)

Risk-adapted OEPA/COPDAC (EuroNet-PHL-C2) or ABVE-PC with brentuximab (AHOD1331, EFS benefit) and PET-guided radiotherapy omission; S1826 and AHOD2131 now enrol from age 12 or 5.

Survivorship

Lifelong surveillance for cardiac disease (anthracycline, mediastinal RT), breast cancer screening from 8 years after chest RT in women, thyroid and lung checks, fertility counselling before therapy.

Subtypes & biomarkers

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Subtypes
Biomarkers clinicians test

Target prevalence in this cancer

History

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  1. 1832Thomas Hodgkin describes the disease; Reed and Sternberg characterise the cell (1898-1902)
  2. 1950Peters shows extended-field radiotherapy can cure early-stage disease
  3. 1964MOPP: first combination chemotherapy cure
  4. 1964MOPP: the first combination chemotherapy to cure an advanced cancer (DeVita, NCI)
  5. 1975ABVD introduced (Bonadonna); becomes global standard by the 1990s
  6. 1992Escalated BEACOPP developed by the German Hodgkin Study Group
  7. 2000Autologous transplant standard for relapse; late-effects registries reveal cardiac and second-cancer burden
  8. 2011Brentuximab vedotin approved
  9. 2011Brentuximab vedotin approved for relapsed disease; CD30 validated as an ADC target
  10. 2014Lugano classification formalises PET staging and the Deauville scale
  11. 2015AETHERA: brentuximab consolidation after transplant
  12. 2016RATHL: bleomycin dropped after negative interim PET; nivolumab approved for relapse (CheckMate 205)
  13. 2018ECHELON-1: BV-AVD approved frontline; radiotherapy omission trials (RAPID, HD16/17) report
  14. 2020KEYNOTE-204: pembrolizumab beats brentuximab in relapse
  15. 2022ECHELON-1 shows overall survival benefit; WHO reclassifies nodular lymphocyte-predominant disease
  16. 2023SWOG S1826: nivolumab-AVD beats BV-AVD (ASCO plenary)
  17. 2024HD21 (BrECADD) published in Lancet; S1826 in NEJM
  18. 2026Nivolumab-AVD approved first line
  19. 2026Nivolumab-AVD approved by FDA (20 March) for ages 12+; HD21 5-year data confirm BrECADD

Pipeline

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Open problems

  • Late toxicity in survivors.
  • Older patients.
  • Late effects dominate: cardiac disease, breast and lung cancer after mediastinal radiotherapy, infertility; survivors need lifelong surveillance that most health systems do not organise.
  • Older patients (>60) have roughly half the cure rate and double the toxicity; the best regimen for them is unsettled.
  • The ~10-15% with primary refractory or early-relapsing disease still need transplant; those failing PD-1 blockade have few options beyond allogeneic transplant.
  • Interim PET has limited positive predictive value; ctDNA-guided designs are unproven.
  • Access: brentuximab and nivolumab are costly and unavailable in many countries where EBV-positive Hodgkin lymphoma is common in children.
  • Nodular lymphocyte-predominant disease is now a separate entity with little trial evidence of its own.
  • Radiotherapy omission trades a few percent of PFS for lower late toxicity; the right trade-off differs by age and sex.

Trials

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Recruiting now (live from ClinicalTrials.gov)

Recruiting trials near you · live from ClinicalTrials.gov
Hodgkin lymphoma
condition: Hodgkin lymphoma
Open on ClinicalTrials.gov →

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Landmark trials in OnCo

Expert centres

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Where the expertise is

Centres linked to this cancer in OnCo

Seeking a second opinion: ask your oncologist for a referral to a high-volume centre; most accept records and pathology by mail or telehealth. In the US, use the NCI's Find a Cancer Center tool or the nonprofit Cancer Commons, which navigates options for advanced cancers at no cost.

Questions to ask

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Bring to your appointment

Questions to ask your oncologist about Hodgkin lymphoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 31 questions

Newly diagnosed

  1. What is my exact diagnosis, stage, and grade, and which tests established them?
    Why: Everything else follows from an accurate stage and subtype.
  2. Which biomarkers have been tested on my tumour (for example Interim PET, CD30, PD-L1, Interim PETafter cycle 2, CD30 and CD15 on Reed-Sternberg cells; CD20 in NLPBL), and what were the results?
    Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
  3. Which subtype is my cancer, and does that change the recommended treatment?
    Why: Recognised subtypes for this cancer include Classical Hodgkin lymphoma: nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte-depleted, Nodular lymphocyte-predominant B-cell lymphoma, Early stagefavourable vs unfavourable.
  4. Is germline (inherited) genetic testing recommended for me or my family?
    Why: Inherited variants can change treatment and matter for relatives.

Advanced stage

  1. For my situation (advanced stage), which of the standard options do you recommend and why?
    Why: Guideline options include: Nivolumab-AVD (2026) or BV-AVD; PET-adapted.
  2. Am I a candidate for Nivolumab, Brentuximab vedotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Early stage, favourable (I-II)

  1. For my situation (early stage, favourable (i-ii)), which of the standard options do you recommend and why?
    Why: Guideline options include: ABVD × 2 + involved-site radiotherapy 20 Gy (HD10), or PET-adapted omission of radiotherapy after 3 cycles if PET-negative (RAPID, HD16) accepting ~5% lower PFS; AHOD2131 tests BV-nivo.
  2. Am I a candidate for Doxorubicin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of AHOD2131 (COG / NCTN) apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Early stage, unfavourable (I-II bulky or risk factors)

  1. For my situation (early stage, unfavourable (i-ii bulky or risk factors)), which of the standard options do you recommend and why?
    Why: Guideline options include: ABVD × 4 + ISRT 30 Gy, or escalated BEACOPP × 2 + ABVD × 2 + RT (HD14/HD17 PET-guided); nivolumab- or BV-containing regimens in trials.
  2. Am I a candidate for Doxorubicin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage (III-IV), age ≤60

  1. For my situation (advanced stage (iii-iv), age ≤60), which of the standard options do you recommend and why?
    Why: Guideline options include: Nivolumab-AVD × 6 (S1826; approved March 2026, no routine radiotherapy) or BV-AVD × 6 with G-CSF (ECHELON-1); in Europe PET-guided BrECADD × 4-6 (HD21) or eBEACOPP; PET-adapted ABVD/AVD (RATHL) where novel agents unavailable.
  2. Am I a candidate for Nivolumab, Brentuximab vedotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of SWOG S1826 and ECHELON-1 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Advanced stage, age >60

  1. For my situation (advanced stage, age >60), which of the standard options do you recommend and why?
    Why: Guideline options include: Nivolumab-AVD (S1826 included older adults with less toxicity than BV-AVD); sequential brentuximab → AVD → brentuximab; avoid bleomycin; ABVD/AVD with dose adaptation.
  2. Am I a candidate for Nivolumab, Brentuximab vedotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of SWOG S1826 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

First relapse, transplant-eligible

  1. For my situation (first relapse, transplant-eligible), which of the standard options do you recommend and why?
    Why: Guideline options include: Salvage (ICE, DHAP, GVD, BV-nivolumab or pembrolizumab-GVD) → PET-negative → high-dose therapy and autologous transplant; brentuximab consolidation for high-risk (AETHERA); PD-1 maintenance in trials.
  2. Am I a candidate for Brentuximab vedotin, Nivolumab, Pembrolizumab, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of AETHERA apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Relapse after transplant or transplant-ineligible

  1. For my situation (relapse after transplant or transplant-ineligible), which of the standard options do you recommend and why?
    Why: Guideline options include: Pembrolizumab (KEYNOTE-204) or nivolumab; brentuximab vedotin if not yet given; BV + nivolumab; allogeneic transplant for fit patients after response; CD30 CAR-T in trials; palliative radiotherapy or bendamustine.
  2. Am I a candidate for Pembrolizumab, Nivolumab, Brentuximab vedotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of KEYNOTE-204 and CheckMate 205 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Paediatric (COG / EuroNet)

  1. For my situation (paediatric (cog / euronet)), which of the standard options do you recommend and why?
    Why: Guideline options include: Risk-adapted OEPA/COPDAC (EuroNet-PHL-C2) or ABVE-PC with brentuximab (AHOD1331, EFS benefit) and PET-guided radiotherapy omission; S1826 and AHOD2131 now enrol from age 12 or 5.
  2. Am I a candidate for Brentuximab vedotin, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Survivorship

  1. For my situation (survivorship), which of the standard options do you recommend and why?
    Why: Guideline options include: Lifelong surveillance for cardiac disease (anthracycline, mediastinal RT), breast cancer screening from 8 years after chest RT in women, thyroid and lung checks, fertility counselling before therapy.

Any stage

  1. Are there clinical trials I could join, for example of AHOD2131 (COG / NCTN), Chemotherapy-free Hodgkin lymphoma: brentuximab + PD-1 in early stage, CD30 CAR-T for multiply relapsed Hodgkin lymphoma, ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ)?
    Why: Trials are how the next standard of care is set; asking early keeps options open.
  2. Would a second opinion at a high-volume centre change anything, and can you help arrange it?
    Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
  3. What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
    Why: Supportive care improves quality of life and helps patients complete treatment.
  4. I read that “Late toxicity in survivors”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.
  5. I read that “Older patients”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.

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Everything relevant

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Direct links plus the targets, companies, and technologies of this cancer's products.

technologies

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3

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institutions

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pathways

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terms

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pairings

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ideas

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Key papers

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Latest papers

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Literature trend1,430 papers in the last 12 months+12% vs prior 12How this is computed
Latest papers · live from Europe PMC
Open in Europe PMC

Query for this cancer: (TITLE:"Hodgkin lymphoma" OR ABSTRACT:"Hodgkin lymphoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Hodgkin lymphoma, not a curated reading list.

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technologies

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companies

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institutions

19

pathways

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terms

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trials

8

pairings

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ideas

14

collections

2

people

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key papers

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