Hodgkin's disease: Recent concepts in classification and treatment

During the last few decades prognostic classification of Hodgkin's disease has been primarily according to the Ann Arbor classification. However, this does not include prognostic subgrouping of the various stages. Consequently, many studies have investigated the prognostic significance of other clinical and laboratory characteristics. Many prognostic factors have been identified, but recent studies have shown that the total tumour burden is by far the most important prognostic factor in Hodgkin's disease, and that most of the other known prognostic factors are related to tumour burden, without independent prognostic significance. Radiotherapy has been the standard treatment in the management of early stage disease. Adjuvant combination chemotherapy improves disease-free but survival but until now no improvement in overall survival has been documented. Combination chemotherapy alone has been tested in too few trials to allow a final conclusion. Advanced disease is treated with combination chemotherapy. The MOPP regimen and its modifications seem equally effective. For MOPP failures ABVD and other supposedly non-cross-resistant combinations seem equally effective and able to produce prolonged disease-free survival in only about 20% of these patients. In some studies alternating regimens such as MOPP/ABVD for previously untreated patients have produced better results than MOPP alone and are currently being evaluated in larger series of patients. For patients with disease resistant to standard chemotherapy the outlook is still poor. High dose chemotherapy and total body irradiation followed by bone marrow transplantation have shown some promise. Hopefully, in the future new biological techniques will make new types of treatment available or allow a more intensive therapy with the drug combinations currently used.