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Annals of Oncology 2006 17(Supplement 4):iv15-iv17; doi:10.1093/annonc/mdj993
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© 2006 European Society for Medical Oncology

symposium article

Extreme Hodgkin's lymphoma: current problem areas

S. J. Proctor* and J. Wilkinson

Department of Haematological Oncology, University of Newcastle-upon-Tyne, UK

* Correspondence to: S. J. Proctor, University of Newcastle upon Tyne, Haematological Sciences, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. Tel: +44-191 222 7791; Fax: +44-191 222 5524; E-mail: S.J.Proctor{at}newcastle.ac.uk

In Hodgkin's lymphoma therapy, there remain areas of extreme difficulty. This article briefly explores these areas and provides evidence that risk-related therapy and web-based data collection programmes can facilitate progress. Unpublished data from the northern region of the UK suggest that risk-based therapy among poor-prognosis Hodgkin's lymphoma patients aged 15–19 years is improving outcome. An index developed at the Memorial Sloan-Kettering Cancer Centre (MSKCC) for patients undergoing salvage therapy shows that new second-line regimens are urgently needed for those with poor prognosis. In primary therapy and relapse, both adolescent and adult patients with Hodgkin's lymphoma should receive treatment tailored to their degree of risk. Elderly patients with Hodgkin's lymphoma are also difficult to treat and fewer than 2% enter randomised clinical trials. We require new means of encouraging international pooling of data and treatment evaluation in such patients. The SHIELD project (Study of Hodgkin's lymphoma in the Elderly Lymphoma Database; www.shieldstudy.co.uk) is now successfully providing on-line registration in the ongoing phase II study of VEPEMB (vinblastine, cyclophosphamide, procarbazine, prednisolone, mitoxantrone and bleomycin) in the elderly and guidance on obtaining ethical approval for participation.

Key words: Hodgkin's lymphoma, prognostic index, salvage therapy, adolescent, elderly


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