Progress in the Treatment of Advanced-Stage Classical Hodgkin Lymphoma in the PET-Adapted Era

Interim fluorodeoxyglucose (FDG)-PET is currently the most used predictor of early response to treatment in advanced-stage Hodgkin lymphoma. Patients with a negative PET after 2 cycles of chemotherapy (PET2) have a better treatment outcome than their counterparts. The objective of this review was to assess how PET-adapted treatment approaches have enhanced the management of advanced-stage Hodgkin lymphoma by adapting treatment according to initial response. PubMed, Web of Science, ScienceDirect, Google Scholar, Scopus, and the Cochrane Library were systematically searched using randomized controlled trials, phase 2/3 clinical trials, and systematic reviews between 2000 and 2024. Keywords used were "Hodgkin lymphoma," "PET-adapted treatment," "ABVD," "BEACOPP," "interim PET," and "treatment escalation/de-escalation." PET-adapted treatment strategies decrease PET2-negative patient treatment, decreasing adverse effects with no reduction in effectiveness, as evidenced by the RATHL, AHL2011, and HD18 trials. In PET2-positive patients, trials such as SWOG S0816 and HD0607 prove that the early intensification of treatment improves survival. Novel treatments, such as brentuximab vedotin and nivolumab, are promising options.