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EHA 2026 | Future frontline Hodgkin lymphoma strategies aim to reduce treatment toxicity
Graham Collins, MA, MBBS, MRCP, FRCPath, DPhil, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, discusses the future of frontline Hodgkin lymphoma treatment, emphasizing the importance of reducing long-term toxicities while maintaining high cure rates. He explores the growing role of response-adapted strategies, cell-free DNA (cfDNA) analysis, and the potential move toward less chemotherapy-intensive or even chemotherapy-free approaches. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
So some people would say that Hodgkin lymphoma we’re done with now, you know, the cures are so good, what’s there to research, but actually there’s lots more we need to do. So the treatments we give, whether it’s intensive, such as R-CHOP or escalated BEACOPP, whether it’s a bit less intensive, such as Nivo-AVD or BV-AVD, this is still chemotherapy. If we use an ABVD backbone, we’re giving patients 300 milligrams per meter squared of doxorubicin...
So some people would say that Hodgkin lymphoma we’re done with now, you know, the cures are so good, what’s there to research, but actually there’s lots more we need to do. So the treatments we give, whether it’s intensive, such as R-CHOP or escalated BEACOPP, whether it’s a bit less intensive, such as Nivo-AVD or BV-AVD, this is still chemotherapy. If we use an ABVD backbone, we’re giving patients 300 milligrams per meter squared of doxorubicin. That has a significant risk for their heart later in life. And in young women, it increases their risk of breast cancer. So we really shouldn’t sit on our laurels and think we’ve done everything. You know, we need to be thinking who is doing really well and therefore who can we dose de-escalate? We know from a study from South America that even in advanced stage disease, you just give three cycles of ABVD and many patients are cured. So who are those patients that can be cured with much less chemo? And really the way forward here, I think, is doing cell-free DNA analysis. So we’ve already seen that this has real potential to identify low-risk patients. So we know that already. But what we need to be doing now is to do preferably randomized trials where we can integrate that and show that identifying low-risk patients, randomizing them to standard treatment and less intensive treatment maintains that very high cure rate, but also reduces both short and long-term toxicities. So there’s still a long way to go. And ultimately, why are we giving patients chemotherapy at all? There are many other lymphoma subtypes where we’ve gone chemo-free. And ultimately, that should be our aim. So there’s still a lot to do in the field.
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