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Treatment of Adolescents and Young Adults With Hodgkin Lymphoma
Source: Childhood Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 16, 2025 · Captured 2026-09-09.
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Context: Treatment of Newly Diagnosed Children and Adolescents With Hodgkin Lymphoma
The treatment approach for adolescents and young adults with Hodgkin lymphoma may vary based on community referral patterns and age restrictions at pediatric cancer centers. The optimal approach is debatable.
In patients with intermediate-risk or high-risk disease, the standard of care in adult oncology practices typically involves at least six cycles of ABVD chemotherapy that delivers a cumulative anthracycline dose of 300 mg/m2.[80,81] For more information, see Hodgkin Lymphoma Treatment. In late-health outcome studies of pediatric cancer survivors, the risk of anthracycline cardiomyopathy has been shown to exponentially increase after exposure to cumulative anthracycline doses of 250 to 300 mg/m2.[82,83] Subsequent need for mediastinal radiation can further enhance the risk of several late cardiac events.[84] In an effort to optimize disease control and preserve both cardiac and gonadal function, pediatric regimens for low-risk disease most often feature a restricted number of cycles of ABVD derivative combinations. For those with intermediate-risk and high-risk disease, alkylating agents and etoposide are integrated into anthracycline-containing regimens.
No prospective studies of efficacy or toxicity in adolescent or young adults treated with pediatric versus adult regimens have been reported; however, some secondary analyses have been conducted.[85]
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A retrospective review documented the outcomes of patients aged 17 to 22 years treated in the Eastern Cooperative Oncology Group (ECOG) trials E2496 (NCT00003389) or Stanford V versus the COG trial AHOD0031 (NCT00025259).[86][Level of evidence C2]
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A retrospective review documented the outcomes of patients aged 17 to 22 years treated in the Eastern Cooperative Oncology Group (ECOG) trials E2496 (NCT00003389) or Stanford V versus the COG trial AHOD0031 (NCT00025259).[86][Level of evidence C2]
The 5-year failure-free survival (FFS) rates were 68% for patients in the ECOG trial and 81% for patients in the COG trial, with OS rates of 89% and 97%, respectively.
A retrospective review documented the outcomes of patients aged 17 to 22 years treated in the Eastern Cooperative Oncology Group (ECOG) trials E2496 (NCT00003389) or Stanford V versus the COG trial AHOD0031 (NCT00025259).[86][Level of evidence C2]
Limitations of this study include differences in the study populations. More adolescents and young adults aged 17 to 22 years in the E2496 study had stage III or IV disease and B symptoms, whereas more adolescents and young adults aged 17 to 22 years in the AHOD0031 study had bulky disease and received radiation (although with smaller doses than those in E2496). Some of these differences were addressed using a propensity score analysis that confirmed inferior FFS for adolescents and young adults in the E2496 trial than those in the AHOD0031 trial. The study was also not a prospective randomized trial.
A comprehensive review of differences in outcomes between adolescent and young adult patients treated in pediatric versus adult trials was published.[87] In a retrospective analysis, adolescents (aged ≥15 years) who were treated in risk- and response-adapted Children’s Oncology Group Hodgkin lymphoma trials had worse EFS and OS rates than children (aged <15 years). These trials included AHOD0431 (NCT00302003) for low-risk patients, AHOD0031 [NCT00025259] for intermediate-risk patients, and AHOD0831 (NCT01026220) for high-risk patients.[88]
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A comprehensive review of differences in outcomes between adolescent and young adult patients treated in pediatric versus adult trials was published.[87] In a retrospective analysis, adolescents (aged ≥15 years) who were treated in risk- and response-adapted Children’s Oncology Group Hodgkin lymphoma trials had worse EFS and OS rates than children (aged <15 years). These trials included AHOD0431 (NCT00302003) for low-risk patients, AHOD0031 [NCT00025259] for intermediate-risk patients, and AHOD0831 (NCT01026220) for high-risk patients.[88]
After a median follow-up of 7.4 years, the unadjusted 5-year EFS rates were 80% for older patients and 86% for younger patients (HR, 1.38).
A comprehensive review of differences in outcomes between adolescent and young adult patients treated in pediatric versus adult trials was published.[87] In a retrospective analysis, adolescents (aged ≥15 years) who were treated in risk- and response-adapted Children’s Oncology Group Hodgkin lymphoma trials had worse EFS and OS rates than children (aged <15 years). These trials included AHOD0431 (NCT00302003) for low-risk patients, AHOD0031 [NCT00025259] for intermediate-risk patients, and AHOD0831 (NCT01026220) for high-risk patients.[88]
The unadjusted 5-year OS rates were 96% for older patients and 99% for younger patients (HR, 2.50). In multivariable modeling, older patients were more likely to die than younger patients (HR, 3.08).
A comprehensive review of differences in outcomes between adolescent and young adult patients treated in pediatric versus adult trials was published.[87] In a retrospective analysis, adolescents (aged ≥15 years) who were treated in risk- and response-adapted Children’s Oncology Group Hodgkin lymphoma trials had worse EFS and OS rates than children (aged <15 years). These trials included AHOD0431 (NCT00302003) for low-risk patients, AHOD0031 [NCT00025259] for intermediate-risk patients, and AHOD0831 (NCT01026220) for high-risk patients.[88]
Outcomes varied by histology for older patients. Older patients with non-mixed cellularity histology experienced a significantly increased risk of having an event, compared with younger patients with the same histology (HR, 1.32). Older patients with mixed cellularity had significantly worse unadjusted 5-year EFS rates (77%) than younger patients (94%) (HR, 2.93 unadjusted). This result remained significant after multivariable modeling (HR, 3.72).
The optimal approach for adolescents and young adults with Hodgkin lymphoma is complicated by critical but understudied variables. Factors such as tumor biology, disease control, supportive care needs, and long-term toxicities in adolescents and young adults with Hodgkin lymphoma require further research.
Adolescent and young adult patients with Hodgkin lymphoma should consider participating in a clinical trial. Information about ongoing clinical trials is available from the NCI website.
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