Hodgkin's lymphoma in developing countries: can we go further?☆

Hodgkin’s lymphoma (HL) is a B cell malignancy that affects approximately 8000 new patients in the United States annually.1 This is the most common lymphoma affecting the young population with a higher incidence at ages 15 to 35 years. Because of its particular histological features and biological behavior, HL is highly responsive to chemotherapy and radiation, and therefore is considered a model of successful cancer treatment. In fact, in the last decades, important advances were made regarding HL treatment resulting in unprecedented high cure rates. Elegantly designed clinical trials conducted by important cooperative groups in Europe and North America have set the basis for treatment and established the guidelines for HL management in the modern era. In early-stage disease, treatment based on the ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine) regimen remains the standard of care. Short-course chemotherapy (2–4 cycles) followed by radiotherapy (20–30 Gy) has demonstrated high efficacy and acceptable acute and long-term toxicity, with cure rates that exceed 90%.2 Duration of treatment and doses of radiation depend on the presence of some adverse prognostic factors.3 In advanced-stage HL, the best treatment choice has been a matter of exhaustive debate. In the United States, 6–8 cycles of ABVD remains the standard of care, resulting in 5-year failure-free survival of 60% and 5-year OS of 73%.4,5 In Europe, the German Hodgkin Study Group has developed a more intensive protocol, the escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine,