Das Hodgkin-Lymphom (HL) ist die häufigste hämatologische Neoplasie bei jungen Erwachsenen. Über 80 % der Patienten können mit einer risikoadaptierten Chemo- und/oder Radiotherapie geheilt werden. Die Stadieneinteilung erfolgt abhängig von der Tumorlast und anderen Risikofaktoren in frühe, intermediäre und fortgeschrittene Stadien. Die gründliche Diagnostik vor Therapieeinleitung ist zur korrekten Risikoklassifikation unerlässlich. Die Erstlinientherapie besteht für frühe und intermediäre Stadien aus einer kombinierten Chemo- und Strahlentherapie, wobei frühe Stadien nur 2 Zyklen ABVD (Doxorubicin, Bleomycin, Vinblastin, Dacarbazin) benötigen und intermediäre Stadien mit 2 Zyklen BEACOPPesk (Bleomycin, Etoposid, Doxorubicin, Cyclophosphamid, Vincristin, Prednisolon, Procarbazin), gefolgt von 2 Zyklen ABVD behandelt werden. Fortgeschrittene Stadien werden mit 6 Zyklen BEACOPPesk therapiert, und nur im Fall einer metabolisch aktiven Resterkrankung lokal konsolidierend bestrahlt. Im Rezidiv werden die meist jungen Patienten mit einer Hochdosischemotherapie in kurativer Intention behandelt. Die besonderen Bedürfnisse junger Erwachsene mit Krebs sind vor, während und nach der Therapie zu beachten.Hodgkin lymphoma is the most frequent hematologic neoplasia in young adults. Most patients (>80 %) can be healed with risk-adapted chemo- and/or radiotherapy. The staging into early favorable, early unfavorable, and advanced stages depends on tumor burden and other risk factors. A thorough and complete diagnosis is important for risk classification. State-of-the-art first-line therapies for early favorable and early unfavorable Hodgkin lymphoma are combined radiochemotherapies: In early favorable stages with two cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and in early unfavorable with two cycles of BEACOPPesc (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, procarbazine) therapy followed by two cycles of ABVD. In advanced stages, radiotherapy after six cycles of BEACOPPesc therapy depends on residual metabolic activity after chemotherapy. With curative intent, first choice in relapse is high-dose chemotherapy. The special needs of young adults with cancer must be taken into consideration.

BackgroundSeveral treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care—increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)—were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy.MethodsWe searched the Cochrane Library, Medline, and conference proceedings for randomised controlled trials published between January, 1980, and June, 2013, that assessed overall survival in patients with advanced-stage Hodgkin's lymphoma given BEACOPPbaseline, BEACOPPescalated, BEACOPP variants, ABVD, cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP), hybrid or alternating chemotherapy regimens with ABVD as the backbone (eg, COPP/ABVD, MOPP/ABVD), or doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (the Stanford V regimen). We assessed studies for eligibility, extracted data, and assessed their quality. We then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. We also reconstructed individual patient survival data from published Kaplan-Meier curves and did standard random-effects Poisson regression. Results are reported relative to ABVD. The primary outcome was overall survival.FindingsWe screened 2055 records and identified 75 papers covering 14 eligible trials that assessed 11 different regimens in 9993 patients, providing 59 651 patient-years of follow-up. 1189 patients died, and the median follow-up was 5·9 years (IQR 4·9–6·7). Included studies were of high methodological quality, and between-trial heterogeneity was negligible (τ2=0·01). Overall survival was highest in patients who received six cycles of BEACOPPescalated (HR 0·38, 95% credibility interval [CrI] 0·20–0·75). Compared with a 5 year survival of 88% for ABVD, the survival benefit for six cycles of BEACOPPescalated is 7% (95% CrI 3–10)—ie, a 5 year survival of 95%. Reconstructed individual survival data showed that, at 5 years, BEACOPPescalated has a 10% (95% CI 3–15) advantage over ABVD in overall survival.InterpretationSix cycles of BEACOPPescalated significantly improves overall survival compared with ABVD and other regimens, and thus we recommend this treatment strategy as standard of care for patients with access to the appropriate supportive care.FundingNone.