[Recent advances and future perspectives in the treatment of classical Hodgkin lymphoma].

Abstract

Classical Hodgkin lymphoma (cHL) is a highly curable malignancy, with long-term remission achieved in approximately 85% of patients with limited-stage disease and in about 70% of those with advanced-stage disease following first-line therapy. In limited-stage cHL, treatment is generally guided by appropriate risk stratification, and the combination of ABVD followed by radiotherapy has long constituted the therapeutic backbone. For advanced-stage disease, six cycles of brentuximab vedotin plus AVD (BV-AVD) are currently regarded as the standard first-line treatment, whereas six cycles of ABVD remains a reasonable option for older patients in whom treatment tolerability is a particular concern. In recent years, the results of large-scale clinical trials evaluating first-line regimens incorporating brentuximab vedotin (BV) or immune checkpoint inhibitors (IO), together with interim PET-adapted treatment strategies, have shown promise for further improving treatment outcomes while minimizing the use of radiotherapy. For relapsed or refractory disease, immunotherapeutic approaches, including CD30-directed CAR T-cell therapy, are under active development. In parallel, circulating tumor DNA (ctDNA) is emerging as a promising biomarker for minimal residual disease assessment, and ctDNA-based molecular classification has also been proposed. This review outlines the current status and unresolved challenges of first-line treatment for cHL and discusses future perspectives in this evolving field.