## First-Line Chemotherapy for Classical Hodgkin Lymphoma **Key Point:** ABVD is the standard first-line regimen for classical Hodgkin lymphoma across all stages and age groups, with cure rates exceeding 80–90% in early-stage disease. ### ABVD Regimen Composition | Drug | Mechanism | Role | |------|-----------|------| | Doxorubicin | Topoisomerase II inhibitor, intercalating agent | Anthracycline backbone | | Bleomycin | Glycopeptide antibiotic, DNA strand breaker | Synergistic with doxorubicin | | Vinblastine | Microtubule inhibitor | Mitotic arrest | | Dacarbazine | Alkylating agent | Broad-spectrum cytotoxicity | **High-Yield:** ABVD is preferred over BEACOPP in most centres because: - Lower cardiotoxicity (especially in young patients with long life expectancy) - Lower acute haematologic toxicity - Equivalent or superior long-term outcomes - Better tolerability and quality of life ### Treatment Approach by Stage 1. **Early-stage (IA–IIA):** ABVD × 2–4 cycles ± involved-field radiotherapy (IFRT) 2. **Advanced-stage (IIB–IV):** ABVD × 6–8 cycles ± IFRT to bulky sites 3. **PET-adapted therapy:** Interim PET-CT after 2 cycles guides escalation or de-escalation **Clinical Pearl:** In this patient with stage IIA disease and mediastinal mass (bulky), typical management would be ABVD × 4 cycles followed by IFRT, with interim PET-CT assessment after 2 cycles to guide further therapy. **Warning:** Do not confuse ABVD with older regimens (e.g., MOPP) — ABVD has superior efficacy and tolerability and has been the standard for >30 years.
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