A 32-year-old man presents with mediastinal mass and B symptoms. Biopsy confirms classical Hodgkin lymphoma, stage IIA. What is the drug of choice for first-line treatment?

Question

Accepted Answer

A. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). ## 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.

Answer

B. Stanford V (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone)

Answer

C. Chlorambucil monotherapy

Answer

D. BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)

A 32-year-old man presents with mediastinal mass and B symptoms. Biopsy confirms classical Hodgkin lymphoma, stage IIA. What is the drug of choice for first-line treatment?

Explanation

First-Line Chemotherapy for Classical Hodgkin Lymphoma

ABVD Regimen Composition

Treatment Approach by Stage

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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