Hodgkin Lymphoma Guideline

Urgent presentations — stabilise before staging

Airway or tracheal compression from a bulky mediastinal mass — urgent anaesthetic and ENT or thoracic input. Sedation and general anaesthesia carry a real risk of airway collapse; discuss biopsy technique and positioning with anaesthesia before booking.
Superior vena cava obstruction — assess urgently, image, and involve interventional radiology and oncology together. Not every case needs emergency steroids.
Pericardial effusion with tamponade physiology — echocardiography and cardiology input the same day.
Spinal cord or cauda equina compression — urgent MRI of the whole spine and immediate discussion with clinical oncology and neurosurgery.
Tumour lysis is uncommon in Hodgkin lymphoma but should be anticipated with very high disease burden, renal impairment or rapid proliferation. Follow the local tumour-lysis protocol for risk assessment, hydration and urate-lowering treatment.
Get tissue before corticosteroids wherever it is safe to do so. Steroids can obscure the diagnosis. They should not be withheld when there is a genuine threat to airway, cord or circulation — record the reason and inform the pathologist that steroids were given.

1

Scope, populations and how to read this page

Hodgkin lymphoma is one of the most curable malignancies in haematology. That single fact shapes everything below: treatment selection is a negotiation between disease control now and pulmonary, cardiac, endocrine, fertility and second-cancer harm decades later. A regimen that cures slightly more patients but sterilises more of them is not automatically the better choice, and the reverse is equally true.

There is no single worldwide algorithm. Several defensible first-line platforms coexist, risk-group definitions differ between cooperative groups, and licensing and funding differ between countries. This page is built to show those differences rather than flatten them.

Age bands used on this page

Children

Use the age bound of the treating service and the active protocol. EuroNet-PHL-C1 enrolled patients younger than 18 years; COG AHOD1331 enrolled patients aged 2 to 21 years. Care runs through a paediatric lymphoma MDT.

TYA

UK TYA services commonly cover 16 to 24 years. AYA research populations often use wider ranges. Age alone must not decide the pathway — see section 11.

Adults

Usually 18 years and over in adult guidance, but several first-line trials cap eligibility at 60 years and S1826 enrolled from 12 years. Always quote the trial's own age range.

Disease-state definitions — state these explicitly, do not treat them as synonyms

Definitions used throughout this page. Trials differ; quote the definition used by the trial you are citing.
Term	Working definition	Why it matters
Primary refractory	Failure to reach an adequate response to first-line treatment, or progression during it or shortly after completing it. Time-based cut-offs differ between trials.	Carries a worse prognosis than late relapse and was a stratification factor in AETHERA.^[27]
Relapsed	Recurrence after a documented complete response.	Time from end of first-line treatment to relapse changes salvage intensity and transplant planning.
First relapse	The first recurrence after initial therapy. Split immediately into transplant-eligible and transplant-ineligible.	Transplant intent must be decided before salvage is chosen, not after.
Multiply relapsed / refractory	Disease after several lines of systemic therapy and/or after autologous transplantation.	Different evidence base — mostly single-arm, with PD-1 blockade central.

England — positive NICE recommendations identified for Hodgkin lymphoma at 2 August 2026

Each recommendation applies only inside its exact appraised population and current NHS commissioning arrangements. Wording was read from the live NICE page or the official NICE PDF on 2 August 2026:

TA1059 (7 May 2025) — brentuximab vedotin with doxorubicin, dacarbazine and vinblastine for untreated stage 3 or 4 CD30-positive Hodgkin lymphoma in adults. Updates and replaces the terminated appraisal TA594.
TA524 (13 June 2018) — brentuximab vedotin for CD30-positive Hodgkin lymphoma in adults with relapsed or refractory disease, after autologous transplantation, or after at least two previous therapies when transplantation or multi-agent chemotherapy are unsuitable. Replaces TA446.
TA462 (26 July 2017, updated January 2019) — nivolumab for relapsed or refractory cHL in adults after autologous transplantation and after brentuximab vedotin.
TA772 (23 February 2022) — pembrolizumab from 3 years of age after a failed autologous transplant, or after at least two previous therapies when transplantation is not an option, only if brentuximab vedotin has not been given.
TA967 (1 May 2024) — pembrolizumab from 3 years of age after at least two previous treatments when autologous transplantation is not possible, only if brentuximab vedotin has already been given, stopping at two years or earlier at transplant or progression.
TA540 — recommendation 1.1 remains a negative recommendation; recommendation 1.2 was updated and replaced by TA967. Do not quote the old negative wording against the TA772 or TA967 routes.
TA594 — terminated appraisal, no company submission. A terminated appraisal is not a negative recommendation and is not a positive one. It is now historical: TA1059 carries the first-line recommendation.

TA772 and TA967 are not duplicates and do not overlap: the dividing line is whether brentuximab vedotin has already been given. Read the exact wording, the stopping rule and the commercial arrangement before assuming a patient is eligible.

No positive NICE recommendation was identified for first-line nivolumab plus AVD in untreated stage III–IV cHL as of 2 August 2026, despite the S1826 result. Searches of the live NICE site were partly blocked by the site itself, so this is recorded as "no positive recommendation identified on 2 August 2026" rather than as a statement that none exists. Re-check before using it clinically.

Terminology

The preferred term is Hodgkin lymphoma. Historical paper titles retain "Hodgkin's disease" and are quoted unchanged in the reference list. Classical Hodgkin lymphoma is abbreviated cHL; nodular lymphocyte-predominant disease is abbreviated NLPHL and is handled separately in section 5.

2

Diagnosis and tissue acquisition

Clinical vignette A 19-year-old student presents with three months of a painless left supraclavicular node, night sweats and 8 kg of weight loss. A chest radiograph shows mediastinal widening. She has been told a needle test was "inconclusive". She asks whether she needs another biopsy, and whether treatment will affect her chance of having children.

Referral for suspected lymphoma in the UK follows NICE NG12 (published 23 June 2015, last updated 15 April 2026).^[8] Diagnostic-service organisation, integrated haematopathology reporting and MDT structure are covered by NICE NG47 (25 May 2016), which is service guidance and contains no Hodgkin-specific treatment recommendations.^[7]

Tissue: what to obtain

Excisional lymph-node biopsy is preferred where it is practical and safe. Nodal architecture carries diagnostic weight in Hodgkin lymphoma and is lost on small samples.
Where excision is unsafe or impractical, obtain multiple adequate image-guided core biopsies and preserve material for morphology, immunohistochemistry, EBV studies and any further molecular work.
Fine-needle aspiration alone should not establish a new diagnosis of Hodgkin lymphoma. It may be reasonable for confirming relapse at a previously proven site when the MDT accepts the limitation.
Discuss anaesthetic risk with the anaesthetic team before biopsy in bulky mediastinal disease.
Send fresh tissue where the local service requires it; check local specimen-handling instructions before the list.

When to ask for specialist haematopathology review

Small or crushed samples, or a phenotype that does not fit cleanly.
T-cell-rich lesions, where the differential includes T-cell/histiocyte-rich large B-cell lymphoma and NLPHL.
Anterior mediastinal disease where mediastinal grey-zone lymphoma or primary mediastinal B-cell lymphoma are possible.
Suspected NLPHL, at diagnosis and again at relapse.
Any mismatch between the reported pathology and how the disease is behaving.

3

Classical Hodgkin lymphoma pathology and differential diagnosis

Hodgkin and Reed–Sternberg cells sit in a minority within a reactive background. They are strongly CD30 positive, commonly CD15 positive, show weak B-cell transcription-factor expression such as PAX5, and may express CD20 variably or not at all. EBV status is assessed by EBER in situ hybridisation where it is clinically or pathologically relevant. No single stain is diagnostic on its own — the pattern, the background and the architecture are read together.

Recognised morphological subtypes of cHL are nodular sclerosis, mixed cellularity, lymphocyte-rich and lymphocyte-depleted. Subtype does not by itself drive treatment selection in current practice; stage, risk group, age and metabolic response do.

Differential diagnoses that must be actively excluded before treating as cHL.
Entity	Discriminating features to request
Anaplastic large-cell lymphoma	Strong uniform CD30 with T-cell antigens and ALK status; cytotoxic markers.
Primary mediastinal B-cell lymphoma	Strong pan-B-cell antigen expression with characteristic mediastinal presentation; CD30 is often weak and patchy rather than strong.
Mediastinal grey-zone lymphoma	Features intermediate between cHL and primary mediastinal B-cell lymphoma; needs expert review because treatment differs.
EBV-positive large B-cell proliferations	EBER positivity with a preserved B-cell programme; consider in older and immunosuppressed patients.
NLPHL and T-cell/histiocyte-rich large B-cell lymphoma	LP cells with strong CD20, OCT2, BOB1 and BCL6, usually without the cHL CD30/CD15 pattern; background composition separates the two.

4

Nodular lymphocyte-predominant Hodgkin lymphoma — a separate pathway

NLPHL is not "CD20-positive classical Hodgkin lymphoma"

It is a distinct entity with a different natural history, a different treatment approach and a real risk of transformation to aggressive B-cell lymphoma. Do not apply cHL first-line regimens or cHL trial results to it.

Phenotype. LP cells usually express strong B-cell markers including CD20, OCT2 and BOB1, together with BCL6, and usually lack the CD30/CD15 pattern typical of cHL.
Classification wording. WHO-HAEM5 and the International Consensus Classification use different nomenclature for this entity. Use the terminology of whichever classification you are citing and say which one it is. Do not present the two as interchangeable without checking the source.
Localised stage IA disease may be managed with involved-site radiotherapy. Complete excision followed by observation is used in selected paediatric cases under specialist protocol. Both approaches need paediatric or lymphoma MDT agreement.
More extensive or symptomatic disease generally uses anti-CD20-containing treatment, with or without chemotherapy, chosen by burden, symptoms, age and transformation risk.
Rituximab alone produces responses but relapse is common. If a lower-toxicity strategy is chosen over more durable disease control, say so explicitly to the patient and record it.
At relapse, re-biopsy wherever feasible to confirm NLPHL and exclude transformation. Transformed disease is treated as the aggressive B-cell lymphoma it has become, not as NLPHL.

Source position. The BSH NLPHL guideline was published online in 2015 and in the January 2016 issue.^[5] A search of the BSH guideline library on 2 August 2026 found no replacement. It predates current WHO/ICC terminology, so read it alongside the NLPHL sections of the EHA 2026 guideline.^[1]

5

Baseline assessment, investigations and pretreatment planning

History and examination

Nodal sites, rate of growth, pain, pruritus, fatigue, alcohol-associated nodal pain and any compressive symptoms.
B symptoms defined strictly: unexplained fever above 38°C, drenching night sweats, and unexplained loss of more than 10% of body weight over six months.
Performance status, comorbidity, frailty in older adults, infection history, autoimmune disease and current immunosuppression.
Cardiovascular and respiratory risk, existing neuropathy, thrombotic risk and previous cancer treatment.
Fertility goals, possibility of pregnancy, breastfeeding, contraception, and how urgently treatment must start.
For children and TYA: growth and puberty, schooling or employment, psychosocial support, safeguarding and family circumstances.

Laboratory and infection screen

Consider full blood count and film, ESR, renal and liver profiles, albumin, LDH, calcium, urate and other tumour-lysis parameters proportionate to disease burden. Test for HIV and assess hepatitis B and C before immunochemotherapy, following local policy for any further infection screening. Perform pregnancy testing where relevant. ESR is not an optional extra where a GHSG risk definition is being applied — it is part of that definition (see section 8).

Pretreatment organ assessment

Baseline organ assessment. Trigger each investigation by the planned regimen and local protocol rather than ordering the full set for everyone.
Assessment	When	Notes
Cardiac function (echocardiography or MUGA)	Before anthracycline where indicated by the regimen, prior exposure or cardiac risk.	Follow the local protocol; not every young patient with no cardiac history needs it in every service.
Respiratory assessment before bleomycin	Clinical assessment of respiratory risk in every patient for whom bleomycin is planned.	Routine baseline lung function testing with gas transfer for every patient is not recommended here. The BSH good practice paper on fitness for bleomycin exists precisely because practice varies; use it and the local protocol to decide who needs formal testing and what is done with the result. Do not use a single baseline gas-transfer value as a licence to continue bleomycin in a symptomatic patient.^[6]
Fertility preservation	Discuss before any gonadotoxic treatment, in every age band including adolescents.	Referral must not create an unsafe delay. Record the discussion and the decision, including when preservation was declined or not feasible.
Thyroid function	Where neck irradiation is planned or clinically indicated.	Baseline value supports later survivorship monitoring.
Dental, nutrition, vaccination, vascular access	As appropriate to the regimen and age band.	Paediatric services will have their own standard set.

Flagged for source verification before clinical use

The exact BSH position on which patients need formal baseline respiratory investigation, and on the thresholds for withholding or stopping bleomycin, could not be read in full from the open BSH landing page on 2 August 2026 — the full text sits behind the publisher. Read the good practice paper itself (Br J Haematol 2025;206(1):74–85; published online 6 November 2024) before turning any of this into a local standard.^[6]

6

Staging: PET–CT, Ann Arbor/Lugano, bulk and bone marrow

Baseline FDG PET–CT is the principal staging investigation for FDG-avid cHL and provides the comparator for interim and end-of-treatment assessment. Staging and response criteria follow the Lugano classification (J Clin Oncol 2014;32:3059–3067 — note the publication year is 2014 despite the 2013 element in its DOI).^[9]

Do

Stage with Ann Arbor as applied in Lugano, recording extranodal sites and B symptoms.
Add contrast-enhanced diagnostic CT where anatomical detail will change radiotherapy planning or surgical decisions.
Record bulk using the exact definition attached to the risk system you are applying, and name that system.
Involve nuclear medicine early where the scan will drive treatment escalation.

Do not

Do not mix a 10 cm nodal-diameter bulk definition with a mediastinal mass ratio without saying which you used.
Do not perform routine staging bone-marrow biopsy where modern PET–CT has adequately staged FDG-avid Hodgkin lymphoma. Reserve it for unexplained cytopenias or where the result would change management.
Do not transfer a risk-group label between GHSG and EORTC/LYSA systems.
Do not treat a residual anatomical mass with complete metabolic response as active lymphoma.

7

Early-stage risk definitions and prognostic scores

GHSG and EORTC/LYSA definitions are not interchangeable

They differ in what counts as a large mediastinal mass, how nodal areas are counted, how extranodal involvement is handled, and how ESR interacts with B symptoms. A patient can be "favourable" under one system and "unfavourable" under the other. A trial result generated in one system cannot be transferred to a patient classified under the other. Read the criteria from the source you are applying and record which system you used.

GHSG framing

Used by HD10, HD16 and HD17. Risk factors include a large mediastinal mass, extranodal involvement, raised ESR interpreted alongside B symptoms, and involvement of three or more nodal areas.

Read the exact thresholds and nodal-area map from the GHSG trial publication you are relying on.

EORTC/LYSA framing

Used by H10. Risk factors include a mediastinal-to-thoracic ratio, age, raised ESR interpreted alongside B symptoms, and the number of involved nodal areas — counted differently from the GHSG map.

H10 defined its favourable and unfavourable groups by EORTC criteria; do not relabel those patients with GHSG terms.^[13]

Advanced disease

The International Prognostic Score remains prognostic but does not replace stage, metabolic response, age, fitness or trial-specific eligibility when selecting treatment. If a newer three-factor version is displayed, label it clearly and separately from the original seven-factor score, and cite the source for whichever you use.

8

Response assessment: Deauville, interim PET and end-of-treatment PET

Response is assessed on the Deauville five-point scale within the Lugano framework.^[9] The threshold that counts as "positive" is trial-specific, and the point at which the scan is done is part of the tested strategy, not a free parameter.

Interim PET timing and reported positivity threshold, taken from each trial's own report. Where a trial abstract does not state the Deauville cut-off, that is recorded rather than filled in from another trial.
Trial	Chemotherapy before interim PET	Deauville threshold as reported
RAPID^[12]	3 cycles ABVD	Not stated in the published abstract — read the Methods before quoting a cut-off.
H10^[13]	2 cycles ABVD	Not stated in the published abstract.
GHSG HD16^[14]	2 cycles ABVD	Stated: negative defined as Deauville score below 3; positive as 3 or above, with a sensitivity analysis using a Deauville 4 liver cut-off.
GHSG HD17^[16]	4 cycles (2 escalated BEACOPP then 2 ABVD)	Not stated in the published abstract.
RATHL^[17]	2 cycles ABVD	Central review on a five-point scale; numeric cut-off not stated in the abstract.
GHSG HD18^[18]	2 cycles escalated BEACOPP	Not stated in the published abstract; central review of PET-2.
LYSA AHL2011^[19]	2 cycles escalated BEACOPP	Not stated in the published abstract.
GHSG HD21^[23]	2 cycles	Not stated in the published abstract.

Rules that stop PET being misused

A negative interim PET does not mean zero relapse risk. In HD16, PET-2-negative patients treated with chemotherapy alone still relapsed more often than those who also had radiotherapy.^[14]
Do not mix PET rules between regimens. The HD17 strategy was validated after a specific 2+2 programme; it does not license omitting radiotherapy after any four cycles of anything.
A residual mass with complete metabolic response is not active lymphoma. Do not treat it as such.
Unexpected PET positivity may be inflammatory or infective. Where a positive result would trigger major escalation, consider biopsy or interval reassessment first.
Interim PET and end-of-treatment PET are different tests with different meanings. Label which one you are reporting.

9

Children — newly diagnosed classical Hodgkin lymphoma

Protocol-led care only Protocol

Children are treated through a paediatric lymphoma MDT on a current national or cooperative-group protocol. Paediatric Hodgkin lymphoma treatment is risk- and response-adapted by design: the regimen, the response definition and the radiotherapy decision are one linked strategy. Do not assemble a paediatric plan by shrinking an adult regimen, and do not import a single element of a trial without the response framework it was tested inside.

European paediatric pathways use OEPA-based induction with risk-group-specific consolidation such as COPDAC, and decide radiotherapy on protocol-defined response. The design aim is to keep cure rates high while reducing cumulative anthracycline, alkylator and radiation exposure, because growth, endocrine function, cardiac and pulmonary health, fertility and second cancers are primary outcomes in a population expected to live for decades.

What the paediatric trials actually showed

EuroNet-PHL-C1 — early stage (treatment group 1) Titration study

Radiotherapy was omitted in patients with an adequate response to OEPA.

Population Children and adolescents younger than 18 years with newly diagnosed stage IA, IB or IIA cHL.
Primary endpoint Event-free survival; the objective was to maintain a 5-year event-free survival rate of 90% in adequate responders treated without radiotherapy.
Result In 440 of 713 intention-to-treat patients who had an adequate response and received no radiotherapy, 5-year event-free survival was 86.5% (95% CI 83.3–89.8) — below the prespecified 90% target. In 273 patients with an inadequate response who did receive radiotherapy, 5-year event-free survival was 88.6% (95% CI 84.8–92.5), with a confidence interval that included the 90% target.^[24]
How to read it This supports omitting radiotherapy in adequate responders within the tested framework, while making clear that the formal target was missed and that patients with risk factors may need more intensive treatment. It is not a general licence to drop radiotherapy.
Access Trial-derived strategy delivered under a paediatric protocol; not a licensing or funding question.

EuroNet-PHL-C1 — intermediate and advanced stage (treatment groups 2 and 3) Embedded RCT

Response-adapted omission of radiotherapy, with an embedded randomised comparison of COPDAC against COPP consolidation.

Population Children and adolescents younger than 18 years with intermediate-stage or advanced-stage cHL (stages IIAE, IIB, IIBE, IIIA, IIIAE, IIIB, IIIBE and all stage IV).
Result In adequate responders, 5-year event-free survival was 90.1% (95% CI 87.5–92.7). In the randomised comparison, 5-year event-free survival was 89.9% (95% CI 87.1–92.8) with COPP and 86.1% (82.9–89.4) with COPDAC; the difference was −3.7% (95% CI −8.0 to 0.6) against a −8% non-inferiority margin.^[25]
How to read it The confidence interval reaches the margin. Present this as a trade-off between gonadal toxicity and disease control, not as an unqualified equivalence.

COG AHOD1331 — brentuximab vedotin in paediatric high-risk disease Phase 3 RCT

Brentuximab vedotin replaced bleomycin within an AVE-PC backbone, with protocol-directed radiotherapy.

Population Patients aged 2 to 21 years with previously untreated stage IIB with bulk tumour, or stage IIIB, IVA or IVB Hodgkin lymphoma.
Primary endpoint Event-free survival.
Result 3-year event-free survival 92.1% (95% CI 88.4–94.7) with brentuximab vedotin versus 82.5% (95% CI 77.4–86.5) with standard care; hazard ratio 0.41 (95% CI 0.25–0.67), p<0.001.^[26]
How to read it This applies to the defined high-risk group. Do not extend it to lower-risk paediatric disease on the strength of this trial.
Access UK use is a protocol and commissioning question, not simply a licensing one. Confirm the active national protocol and funding route before assuming availability.

Older Children's Oncology Group response-adapted studies

AHOD0431 reported response-adapted therapy and a salvage strategy for limited-stage cHL (Cancer 2018;124:3210–3219).^[29] AHOD0031 reported dose-intensive response-based chemotherapy and radiotherapy for children and adolescents with intermediate-risk disease (J Clin Oncol 2014;32:3651–3658).^[30] Both inform how North American groups minimise chemotherapy and select patients for radiotherapy. Their risk definitions are not the same as EuroNet risk groups.

Very young children and paediatric NLPHL need specialist and often distinct approaches. Do not extrapolate from the adolescent data above.

Current UK paediatric protocol status — unresolved

The CCLG professional guidelines page was checked on 2 August 2026 and carries no publicly listed Hodgkin-specific guideline; disease-specific material appears to be restricted to members. Confirm the active national paediatric protocol and its current recruitment or successor status with the paediatric principal treatment centre rather than inferring it from a published trial report.

10

Teenagers and young adults — bridging paediatric and adult evidence

TYA patients fall in the overlap between two research traditions that use different risk systems, different response definitions and different assumptions about acceptable late-effect burden. Two clinicians can defend two different plans for the same 17-year-old, and both can point to good evidence. That is the problem this section exists to make visible.

Age ranges of the evidence — quote these, do not blur them

UK TYA services commonly cover 16 to 24 years. Wider AYA research populations are used elsewhere. The service definition and the evidence definition are not the same thing.
EuroNet-PHL-C1 enrolled patients younger than 18 years.^[24]
COG AHOD1331 enrolled patients aged 2 to 21 years.^[26]
SWOG S1826 enrolled patients aged 12 years and over with stage III or IV disease, which is the single most useful bridge across the paediatric/adult divide in advanced disease.^[22]
LYSA AHL2011 enrolled from 16 to 60 years.^[19] GHSG HD17 and HD18 enrolled from 18 to 60 years.^[16]^[18] GHSG HD16 enrolled from 18 to 75 years.^[14] GHSG HD21 enrolled adults aged 60 years or younger.^[23]

What should actually decide the pathway

Disease biology, stage and risk group, assessed with one named risk system.
Eligibility for an open trial or an active national protocol.
Fertility priorities, discussed early and documented, with alkylator and pelvic-radiation exposure made explicit.
Predicted late-effect burden over a very long expected survival — cardiac, pulmonary, endocrine, second cancers.
Education, employment, adherence, transport, and the psychosocial and key-worker support the service can actually provide.
The patient's own preference, once the trade-offs have been described in terms they can use.

Do not let chronological age alone force a pathway. A 17-year-old and a 24-year-old are both "TYA" and may reasonably be treated on entirely different protocols. Record which protocol framework was chosen and why, and make sure the follow-up plan matches that exposure.

11

Adults — early-stage favourable cHL

Disease control in this group is excellent whichever validated strategy is used. The real question is how much late radiation exposure a patient is willing to accept in exchange for a lower relapse risk. Present it that way.

The trade-off in one line

Combined-modality treatment gives the best reported disease control. Omitting radiotherapy after a negative interim PET avoids that radiation exposure but has consistently produced more relapses in randomised trials. Overall survival differences are small and uncertain because salvage treatment for Hodgkin lymphoma works well. This is a preference-sensitive decision, not a settled question.

Combined-modality treatment — abbreviated ABVD then involved-site radiotherapy RCT

Evidence GHSG HD10 established that a reduced-intensity combined-modality approach was adequate within the GHSG favourable early-stage population (N Engl J Med 2010;363:640–652).^[11]
Population GHSG-defined early favourable disease. This label does not transfer to an EORTC/LYSA-classified patient.
Benefits Highest reported disease control in this risk group; short chemotherapy exposure.
Toxicity and late effects Radiation dose to breast, thyroid, lung, heart and coronary vessels depending on field. Modern involved-site radiotherapy with expert planning is not the same exposure as historical extended-field treatment, and historical late-effect figures should not be presented as if they describe it.
Dose and schedule Not reproduced here. Take cycle number, radiotherapy dose and field from the local or national protocol.

PET-directed chemotherapy alone — omitting radiotherapy RCT

RAPID Stage IA/IIA, interim PET after 3 cycles of ABVD. 3-year progression-free survival 94.6% (95% CI 91.5–97.7) with radiotherapy versus 90.8% (95% CI 86.9–94.8) with no further treatment; absolute difference −3.8 percentage points (95% CI −8.8 to 1.3). The trial did not show non-inferiority of omitting further treatment.^[12]
H10 Interim PET after 2 cycles of ABVD in EORTC-defined favourable and unfavourable stage I–II disease. In interim-PET-negative favourable patients 5-year progression-free survival was 99.0% with combined modality versus 87.1% with ABVD alone (hazard ratio 15.8, 95% CI 3.8–66.1); in the unfavourable group 92.1% versus 89.6% (hazard ratio 1.45, 95% CI 0.8–2.5). Non-inferiority of ABVD alone was not demonstrated in either group.^[13]
GHSG HD16 Age 18–75, interim PET after 2 cycles of ABVD, negative defined as Deauville below 3. Among 628 PET-2-negative per-protocol patients, 5-year progression-free survival was 93.4% (95% CI 90.4–96.5) with combined modality versus 86.1% (95% CI 81.4–90.9) with ABVD alone; difference 7.3 percentage points (95% CI 1.6–13.0), hazard ratio 1.78 (95% CI 1.02–3.12). Non-inferiority was not met. Longer follow-up reported 5-year progression-free survival of 94.2% versus 86.7%, hazard ratio 2.05 (95% CI 1.20–3.51), p=0.0072.^[14]^[15]
Benefit Avoids radiotherapy and its late exposure entirely in patients who never relapse.
Cost A consistent excess of relapses across three randomised trials, and therefore more patients exposed to salvage chemotherapy and transplantation.

How to present this to a patient. Roughly: "Adding radiotherapy makes relapse less likely. Leaving it out avoids radiation to your chest, breast or thyroid, but a few more people in your position will relapse and need stronger treatment. Survival looks similar either way in the trials, because treatment at relapse works well." Then give the numbers from the trial that matches their risk classification, not an average across trials.

12

Adults — early-stage unfavourable cHL

A common baseline is four cycles of ABVD followed by involved-site radiotherapy, modified by which risk system is being applied and by interim metabolic response. Two randomised results define the current options, and neither is transferable outside its own design.

PET-directed escalation — H10 unfavourable RCT

Result In interim-PET-positive patients, escalating from ABVD plus involved-node radiotherapy to escalated BEACOPP plus involved-node radiotherapy improved 5-year progression-free survival from 77.4% to 90.6% (hazard ratio 0.42, 95% CI 0.23–0.74, p=0.002).^[13]
Population EORTC-defined stage I–II disease. Escalation was applied after 2 cycles of ABVD, inside the H10 algorithm.
Caveat Escalated BEACOPP carries greater haematological toxicity, infection risk and gonadal toxicity. The benefit shown here is for the PET-positive subgroup only.

PET-directed radiotherapy omission after a 2+2 programme — GHSG HD17 RCT

Population Age 18 to 60 years, newly diagnosed early-stage unfavourable Hodgkin lymphoma, performance status 2 or better.
Strategy Two cycles of escalated BEACOPP followed by two cycles of ABVD, with PET after four cycles.
Result 5-year progression-free survival 97.3% (95% CI 94.5–98.7) with standard combined-modality treatment versus 95.1% (95% CI 92.0–97.0) with the PET-guided strategy; difference 2.2 percentage points (95% CI −0.9 to 5.3), which excluded the prespecified 8% non-inferiority margin.^[16]
How to read it Radiotherapy can be omitted after a negative PET following this specific intensified programme. It does not validate omitting radiotherapy after any four cycles of any regimen.
Fertility The escalated BEACOPP component carries gonadal toxicity. Fertility discussion must precede treatment.

13

Adults — advanced-stage cHL: four coexisting platforms

There is no single global standard here. Four evidence-based platforms coexist. They differ in the population studied, the age range enrolled, the toxicity accepted, the fertility consequences, the maturity of follow-up, and whether they can be funded in England. The comparison table below is the core of this page.

First-line platforms for advanced cHL in adults. Populations and results are taken from each trial's own report; access is the position identified on 2 August 2026.
Platform	Population studied	Headline result	Main toxicity and fertility concerns	England access
PET-directed ABVD → AVD RCT	Newly diagnosed advanced cHL; interim PET after 2 cycles. Age limits not stated in the RATHL abstract.	3-year progression-free survival 85.7% (95% CI 82.1–88.6) continuing ABVD versus 84.4% (95% CI 80.7–87.5) after dropping bleomycin; difference 1.6 percentage points (95% CI −3.2 to 5.3). The result fell just short of the 5% non-inferiority margin, with less pulmonary toxicity in the AVD group.^[17]	Bleomycin lung toxicity during the first two cycles; anthracycline cardiac exposure. Generally the least gonadotoxic of the four.	Established generic chemotherapy; no technology appraisal needed. Standard chemotherapy
Brentuximab vedotin + AVD RCT	Previously untreated stage III or IV classic Hodgkin lymphoma. Age limits not stated in the ECHELON-1 abstract.	2-year modified progression-free survival 82.1% (95% CI 78.7–85.0) versus 77.2% (95% CI 73.7–80.4) with ABVD; hazard ratio 0.77 (95% CI 0.60–0.98), p=0.03.^[20] With median follow-up of 73.0 months, overall survival — a key secondary, not the primary, endpoint — favoured brentuximab vedotin plus AVD, hazard ratio 0.59 (95% CI 0.40–0.88), p=0.009.^[21]	Peripheral neuropathy and neutropenia; primary granulocyte colony-stimulating factor support is generally required. Check the protocol.	NICE TA1059 (7 May 2025) recommends it within its marketing authorisation for untreated stage 3 or 4 CD30-positive Hodgkin lymphoma in adults, subject to the commercial arrangement.^[44] TA1059
Nivolumab + AVD RCT	Patients aged at least 12 years with newly diagnosed stage III or IV Hodgkin lymphoma. No upper age limit stated in the abstract.	2-year progression-free survival 92% (95% CI 89–94) versus 83% (95% CI 79–86) with brentuximab vedotin plus AVD; hazard ratio 0.45 (95% CI 0.30–0.65). At the second interim analysis the efficacy threshold was crossed, hazard ratio 0.48 (99% CI 0.27–0.87), two-sided p=0.001.^[22]	Immune-related toxicity across multiple organs. Very-long-term and fertility data are less mature than for ABVD-based treatment.	No positive NICE recommendation identified on 2 August 2026 for this first-line indication. Do not present it as NHS-funded first-line care. No NICE route identified
PET-directed escalated BEACOPP RCT	Age 18 to 60 years, newly diagnosed advanced-stage disease; interim PET after 2 cycles.	In PET-2-negative patients, 5-year progression-free survival was 90.8% (95% CI 87.9–93.7) with 8 or 6 cycles versus 92.2% (95% CI 89.4–95.0) with 4 cycles; difference 1.4 percentage points (95% CI −2.7 to 5.4) against a 6% margin, so fewer cycles were non-inferior. Adding rituximab in PET-2-positive patients did not improve outcome (89.7% versus 88.1%).^[18]	Substantial acute haematological toxicity, infection, infertility and second-malignancy concern. Generally restricted to fit younger adults.	Generic chemotherapy; delivery depends on centre experience and local protocol. European practice
PET-directed BrECADD RCT	Adults aged 60 years or younger with newly diagnosed advanced-stage cHL (stage III/IV, or stage II with B symptoms plus a large mediastinal mass and/or extranodal lesions); PET after 2 cycles.	Treatment-related morbidity 42% (312/738) with BrECADD versus 59% (430/732) with escalated BEACOPP; relative risk 0.72 (95% CI 0.65–0.80), p<0.0001. At median 48 months, 4-year progression-free survival 94.3% (95% CI 92.6–96.1) versus 90.9% (88.7–93.1); hazard ratio 0.66 (95% CI 0.45–0.97), p=0.035. 4-year overall survival 98.6% versus 98.2%.^[23]	Better tolerated than escalated BEACOPP but still an intensive regimen requiring experienced delivery, growth-factor support and fertility counselling.	Brentuximab vedotin is a component; TA1059 covers brentuximab vedotin with doxorubicin, dacarbazine and vinblastine, which is not BrECADD. Confirm the funding route locally before offering it. No specific NICE route identified

Rules for using this table

Do not mix components or PET rules between platforms. Each PET decision rule was validated inside one regimen.
Do not compare hazard ratios across rows. The comparators, endpoints and follow-up durations differ. ECHELON-1 used modified progression-free survival; S1826 used progression-free survival; HD21 used treatment-related morbidity and progression-free survival as hierarchical coprimary objectives.
Do not read a licence as funding. Efficacy, marketing authorisation and NHS commissioning are three separate checks.
Dose, schedule and supportive care are not on this page. Take them from a validated protocol.

LYSA AHL2011 — de-escalating after escalated BEACOPP

AHL2011 enrolled patients aged 16 to 60 years with stage III, IV or stage IIB disease with a mediastinum-to-thorax ratio of 0.33 or greater or extranodal involvement, excluding NLPHL. All received two cycles of upfront escalated BEACOPP before PET2. 5-year progression-free survival by intention to treat was 86.2% (95% CI 81.6–89.8) with standard treatment versus 85.7% (81.4–89.1) with the PET-driven strategy; hazard ratio 1.084 (95% CI 0.737–1.596), against a 10% non-inferiority margin. The published abstract states that PET after two cycles safely guided treatment and allowed ABVD in early responders without impairing disease control, but does not itself state that the non-inferiority boundary was formally met — do not make a stronger claim than that from the abstract alone.^[19]

14

Older and less fit adults

The evidence gap is the finding

Several of the trials above excluded patients over 60. HD16 is the exception, enrolling to 75 years.^[14] Older adults therefore carry the highest treatment-related risk and have the thinnest randomised evidence base. Say so rather than extrapolating quietly.

Assess fitness formally — comorbidity, frailty, function, cognition, polypharmacy, social support — rather than using chronological age as a proxy.
Bleomycin risk rises with age and comorbidity. Prolonged bleomycin exposure in older adults should be avoided. Use the BSH good practice paper and the local protocol to plan assessment, monitoring and the response to any respiratory symptom.^[6]
Anthracycline fitness, existing neuropathy, falls risk and infection risk should shape the regimen and the supportive-care plan, not just the dose.
Less intensive or sequential brentuximab-based approaches have been studied in selected older patients, but the supporting evidence is largely single-arm and the England funding route for first-line use outside TA1059's population has not been identified. Label both limitations when discussing it.
Early involvement of the supportive and palliative care team helps with symptoms and decisions and does not replace treatment given with curative intent.

15

First relapse or primary refractory disease — transplant-eligible pathway

Reassess before you treat

Re-biopsy wherever feasible, particularly after a long remission, at an atypical or isolated site, or where a second malignancy is possible.
Restage with PET–CT and document previous dose intensity, radiotherapy fields, cumulative anthracycline and bleomycin exposure, existing neuropathy, any previous immune toxicity, fertility status and organ function.
Decide transplant intent before choosing salvage, and involve the transplant service at that point rather than after two lines have been given.

Transplant-intent salvage sequence · educational schematic

Educational schematic of the sequence described in the text below. It is a visual summary, not a protocol, and it does not replace transplant-service assessment.

The curative backbone

For fit patients, the curative structure has not changed: response-inducing salvage treatment, then high-dose therapy with autologous transplantation, ideally after a complete metabolic response has been achieved. The randomised foundation for high-dose therapy over conventional salvage comes from the BNLI trial (Lancet 1993;341:1051–1054)^[32] and the GHSG/EBMT HD-R1 trial (Lancet 2002;359:2065–2071)^[33] Historical RCT. Both predate PET-based response assessment and every modern agent; they justify the transplant step, not the choice of salvage regimen.

Current transplant indications, sequencing and the handling of novel agents around transplantation are set out in the ASTCT 2026 recommendations (Transplant Cell Ther 2026;32:250–260)^[42] and the EBMT 2026 recommendations for adults (Lancet Haematol 2026;13:e484–e493).^[43] Use those rather than the 2014 BSH relapsed and refractory guideline, which remains available and citable but predates routine brentuximab vedotin and PD-1 sequencing.^[4]

Salvage options — labelled by study design

Conventional salvage chemotherapy Centre practice

Platinum- or gemcitabine-containing multi-agent regimens are used by centre convention. Named examples include ICE, DHAP, GDP, IGEV and ESHAP.

Evidence design No randomised hierarchy establishes one of these as best. Choice reflects centre practice, previous exposure, organ function and stem-cell mobilisation considerations.
Dose and schedule Not reproduced here. Use the local or national protocol.
Access Established chemotherapy; funding is not the limiting factor.

Pembrolizumab plus gemcitabine, vinorelbine and liposomal doxorubicin Phase II single-arm

Population Transplant-eligible patients with relapsed or refractory cHL after first-line therapy. No age limit is stated in the published abstract — take eligibility from the full report or the trial registration, not from here.
Primary endpoint Complete response after up to four cycles, defined by PET with a Deauville score of 3 or less.
Result Of 38 evaluable patients, overall response 100% and complete response 95%. The abstract reports no confidence intervals for these figures.^[39]
How to read it High metabolic complete-response and transplant rates from a single-arm study. Cross-trial comparison with other salvage regimens is not reliable.
Access No England funding route for this specific second-line combination was identified on 2 August 2026. No NICE route identified

Brentuximab vedotin plus nivolumab Phase I/II single-arm

Design Chemotherapy-sparing first salvage; three-year results published in Blood 2021;138:427–438.^[40]
How to read it Active and non-randomised. Attractive where avoiding cytotoxic salvage matters, but without a randomised comparator.
Access No England funding route identified for this combination in first salvage on 2 August 2026. No NICE route identified

Brentuximab vedotin plus bendamustine Phase I/II single-arm NHSE policy

Evidence Active first-salvage bridge to autologous transplantation, reported as a single-arm study in Blood 2018;132:40–48, with infusion-reaction and toxicity considerations.^[41]
England access NHS England clinical commissioning policy 2404, published 16 July 2026, makes brentuximab vedotin with bendamustine routinely commissioned for patients aged 8 years and above with relapsed or refractory classical Hodgkin lymphoma within the criteria in that document.^[51]
Read the policy, not this summary The inclusion criteria cover performance status, prior lines or previous autologous transplantation, and lymphoma or paediatric MDT assessment; exclusions cover previous bendamustine, inadequate previous response to brentuximab vedotin, contraindications and pre-existing grade 3 or higher neuropathy. Take the exact criteria from the live PDF. Parts of that policy document need checking before quoting — see the unresolved-items list in section 23.

Single-agent bendamustine — a negative England policy

NHS England clinical commissioning policy statement 1828 (document dated July 2020) states that bendamustine is not recommended as a treatment option for relapsed or refractory classical Hodgkin lymphoma, with eligibility criteria recorded as "not applicable".^[52] Do not cite that page as a route of access to single-agent bendamustine. It stands in contrast to policy 2404 above, which does commission bendamustine in combination with brentuximab vedotin.

After autologous transplantation — consolidation

Brentuximab vedotin consolidation (AETHERA) Phase 3 RCT Not a NICE-recommended indication

Efficacy — what the trial showed In patients with unfavourable-risk relapsed or primary refractory classic Hodgkin lymphoma who had undergone autologous transplantation, brentuximab vedotin consolidation starting 30 to 45 days after transplant improved progression-free survival by independent review: hazard ratio 0.57 (95% CI 0.40–0.81), p=0.0013; median progression-free survival 42.9 months (95% CI 30.4–42.9) versus 24.1 months (11.5 to not estimable).^[27] Randomisation was stratified by best response to salvage and by primary refractory disease versus relapse within 12 months versus relapse at 12 months or later. Benefit persisted at five years.^[28]
England access — a separate question with a different answer NICE TA524 does not recommend brentuximab vedotin as routine consolidation after autologous transplantation in high-risk patients. TA524 recommends it for adults with relapsed or refractory CD30-positive Hodgkin lymphoma who have already had autologous transplantation, or who have had at least two previous therapies when transplantation or multi-agent chemotherapy are unsuitable.^[45] Those are treatment indications for active disease, not a post-transplant maintenance indication. Confirm the funding route locally before planning consolidation.
Clinical caveats AETHERA largely predates routine first-line and first-salvage brentuximab vedotin. Previous exposure, previous response, and existing neuropathy all change the calculation. The trial abstract does not itself enumerate every entry criterion — read the protocol before applying the "high-risk" label.

Involved-site radiotherapy to selected localised residual or high-risk sites may be considered within an MDT plan around transplantation. Field, dose and timing are radiotherapy decisions and are not reproduced here.

16

First relapse — transplant-ineligible pathway

Choose by previous exposure, disease tempo, comorbidity, patient goals and access. Reassess transplant eligibility if a well-tolerated treatment produces a deep response and fitness improves — ineligibility at relapse is not always permanent.

Options with an identified England route

Pembrolizumab from 3 years of age — TA772 where brentuximab vedotin has not been given, or TA967 where it has, each within its exact prior-treatment and stopping conditions.^[47]^[48]
Nivolumab in adults after autologous transplantation and brentuximab vedotin — TA462.^[46]
Brentuximab vedotin in adults after autologous transplantation, or after at least two previous therapies when transplantation or multi-agent chemotherapy are unsuitable — TA524.^[45]
Brentuximab vedotin with bendamustine from 8 years of age — NHS England policy 2404.^[51]

Other approaches — check the route each time

Gemcitabine-containing regimens and other lower-intensity chemotherapy by centre practice.
Local radiotherapy for symptomatic or localised disease.
Clinical trial entry, which should be considered at every decision point.
Symptom-directed care and early supportive-care involvement where treatment intent is not curative.
Single-agent bendamustine is the subject of a negative NHS England policy — see the box in section 15.^[52]

17

Relapse after autologous transplantation, and multiply relapsed or refractory disease

Pembrolizumab Phase 3 RCT TA772 / TA967

Randomised evidence KEYNOTE-204 enrolled patients aged 18 years or older with relapsed or refractory cHL, measurable disease, performance status 0 or 1, who were ineligible for or had relapsed after autologous transplantation. Dual primary endpoints were progression-free survival by blinded independent central review and overall survival (not analysed at that interim point). Median progression-free survival 13.2 months (95% CI 10.9–19.4) with pembrolizumab versus 8.3 months (95% CI 5.7–8.8) with brentuximab vedotin; hazard ratio 0.65 (95% CI 0.48–0.88), p=0.0027.^[35]
Supporting single-arm evidence KEYNOTE-087, reported first in 2017 and with two-year follow-up in 2019.^[37]^[36] Phase II
England access TA772 and TA967 both start at 3 years of age and are divided by whether brentuximab vedotin has already been given. TA967 also carries a two-year stopping rule. Read both before assuming eligibility.^[47]^[48]

Nivolumab Phase II TA462

Evidence CheckMate 205 reported durable activity with five-year survival follow-up in Blood Advances 2023;7:6266–6274.^[38] This is a single-arm phase II dataset, not a randomised comparison.
England access TA462 covers adults after autologous transplantation and after brentuximab vedotin.^[46]

Brentuximab vedotin Phase II TA524

Evidence The registration phase II study established substantial single-agent activity in CD30-positive cHL after autologous transplantation (J Clin Oncol 2012;30:2183–2189).^[34]
When it still helps Where the disease is brentuximab-naive or was previously sensitive, and neuropathy allows. Previous exposure and previous response are the two things to check first.
England access TA524, in adults, within its stated prior-treatment conditions.^[45]

Allogeneic transplantation

Allogeneic haematopoietic cell transplantation remains potentially curative for selected patients with responsive disease after autologous transplantation or after novel agents. Refer early to a transplant centre. Previous PD-1 blockade changes the risk profile, and washout, conditioning, graft-versus-host disease prophylaxis and timing are transplant-protocol decisions. Use the ASTCT 2026 and EBMT 2026 recommendations for indications and sequencing.^[42]^[43]

Cellular and bispecific therapies

CD30-directed CAR-T cells and bispecific antibody approaches in Hodgkin lymphoma are investigational or jurisdiction-specific. Do not present them as routine NHS care. Prioritise a clinical trial, and check current commissioning before making any claim about availability.

Chemotherapy can regain activity after PD-1 exposure, but the supporting evidence is largely non-randomised. For repeated progression, integrate symptom control, palliative radiotherapy, transfusion and infection support, and advance-care planning aligned to what the patient wants.

18

Relapsed and refractory disease in children and TYA

The EuroNet paediatric group published risk- and response-adapted recommendations for first relapsed and refractory cHL in children and young people (HemaSphere 2020;4(1):e329).^[31] They predate several modern combinations, so the framework is useful while the individual agents need updating against current evidence and current age-specific licensing.

Central specialist review and repeat pathology carry even more weight than in adults.
Risk-stratify by time to relapse, initial stage, site and bulk, previous radiotherapy fields, and response to reinduction.
Selected low-risk late relapses may be cured with limited chemotherapy with or without radiotherapy under protocol. Higher-risk relapse commonly requires reinduction followed by autologous transplantation.
Brentuximab vedotin and PD-1 inhibitors are active in paediatric and AYA relapsed disease and can bridge to transplantation. Age-specific licensing and access must be checked: pembrolizumab routes under TA772 and TA967 start at 3 years,^[47]^[48] and the NHS England brentuximab vedotin with bendamustine policy starts at 8 years.^[51] TA524 and TA462 are adult recommendations.
Do not copy adult salvage doses or adult transplant criteria into paediatric practice. Late immune effects and growth considerations differ.

19

Pregnancy, HIV and viral hepatitis, and urgent bulky disease

Pregnancy

Joint care from the first conversation

Obstetrics, haematology, radiology, neonatology and pharmacy should be involved together from the outset.
Use ultrasound and MRI where appropriate to limit fetal radiation exposure. PET–CT is generally avoided in pregnancy.
The need for and timing of treatment depend on trimester, symptoms, disease burden and any threat to organ function.
ABVD carries the largest reported experience in pregnancy where systemic treatment cannot wait, but every statement about timing, delivery planning and breastfeeding requires specialist source verification for the individual case. This page deliberately does not carry those thresholds.
Never recommend termination solely because Hodgkin lymphoma has been diagnosed.

HIV and viral hepatitis

Treat with curative intent where feasible, under joint HIV and haematology care. Optimise antiretroviral therapy, check drug interactions with the chosen regimen, and plan infection prophylaxis. Hepatitis B management must follow serology and the immunosuppressive content of the regimen; involve hepatology or virology early.

Urgent bulky mediastinal disease

See the urgent presentations strip at the top of this page. The two decisions that matter most are securing safe diagnostic tissue and protecting the airway, and they need to be made together rather than sequentially.

20

Regimen-linked supportive care and toxicity alerts

Toxicity alerts tied to the agent that causes them. Doses, thresholds and monitoring intervals come from the local protocol and the current Summary of Product Characteristics.
Agent or class	Alert	Practical action
Bleomycin	Pulmonary toxicity, rising with age and comorbidity.	Assess fitness before use and review respiratory symptoms at every cycle. Investigate new breathlessness or cough urgently rather than waiting for the next scheduled visit. Avoid excess supplemental oxygen where clinically feasible, but never withhold oxygen that a patient needs. Follow the BSH good practice paper.^[6]
Anthracyclines	Cardiac toxicity, cumulative and lifelong.	Record cumulative dose in the treatment summary. Assess cardiac function as directed by regimen and risk. Carry the exposure forward into the survivorship plan.
Vinca alkaloids and brentuximab vedotin	Peripheral neuropathy, which can be dose-limiting and persistent.	Grade at every cycle using the same scale each time. Escalate early — neuropathy that is allowed to become severe often does not fully resolve.
Checkpoint inhibitors	Immune-related toxicity affecting thyroid, lung, gut, liver, skin, endocrine organs and more.	Follow the local immune-toxicity pathway. Give the patient an alert card. Ensure the on-call team can recognise late-onset immune events.
Escalated BEACOPP and BrECADD	Marked haematological toxicity, infection risk and gonadal toxicity.	Growth-factor support, infection prophylaxis and fertility counselling per protocol. Deliver in a centre familiar with the regimen.
All regimens	Antiemesis, infection prophylaxis and growth-factor policy vary by regimen.	Follow the regimen-specific protocol. Do not delay chemotherapy for uncomplicated neutropenia where the validated protocol specifies full, on-time treatment — confirm the rule in your own protocol before applying it.

21

End of treatment, follow-up and survivorship

The single most-quoted follow-up rule

Do not perform routine surveillance PET–CT in a patient who is asymptomatic and in remission. Follow-up should be principally clinical, supported by history, examination and targeted investigation when something changes. End-of-treatment assessment uses PET–CT at an evidence-based interval with Lugano criteria.^[9]

Exposure-based survivorship plan

Every patient finishing treatment should leave with a written treatment summary recording cumulative anthracycline dose, whether bleomycin was given, alkylator exposure, radiotherapy field and dose, and any immune toxicity. The survivorship plan is then built from that exposure record rather than from a generic template.

Track by exposure

Cardiovascular disease — anthracycline and mediastinal radiotherapy.
Thyroid dysfunction — neck and mediastinal radiotherapy.
Pulmonary effects — bleomycin and thoracic radiotherapy.
Fertility and gonadal function — alkylators and pelvic exposure.
Second cancers — radiotherapy field and alkylator exposure.
Psychosocial health, fatigue, return to education or work.

Do not hard-code screening ages

Breast, colorectal, skin and other post-radiotherapy screening must follow current national exposure- and age-based recommendations. Those thresholds change. Check the current national guidance at the time of writing each survivorship plan rather than copying an age from an older document.

Also cover smoking cessation, exercise, weight, vaccination and a named primary-care contact.

22

UK, Europe, US and wider international comparison

Which document to reach for, and what each one cannot tell you. Verified 2 August 2026.
Region	Source	Role	Limitation
Europe / global	EHA Clinical Practice Guidelines, HemaSphere 2026^[1]	The principal current adult and AYA backbone across diagnosis, staging, first-line, recurrent disease, older adults, NLPHL and follow-up. Open access.	Adult-oriented. Paediatric protocols and national access rules still apply.
Europe	ESMO consolidated lymphoma guideline, Ann Oncol 2025^[2]	Current ESMO cross-check. Note the real title is "Lymphomas" — it is a single consolidated document covering several entities, not a Hodgkin-specific guideline.	May be paywalled; do not reproduce proprietary text.
UK	BSH first-line cHL guideline 2022^[3]	The UK framework for first-line management.	Predates S1826, HD21 and TA1059. Read alongside EHA 2026.
UK	BSH relapsed and refractory cHL guideline 2014, published online 2013^[4]	Historical curative salvage and transplant backbone.	No BSH replacement was found in the live guideline library on 2 August 2026. Predates routine brentuximab vedotin and PD-1 sequencing. Supplement with EHA, ASTCT and EBMT.
UK	BSH good practice paper on fitness for bleomycin, published online 6 November 2024, Br J Haematol 2025^[6]	The only BSH Hodgkin output in the 2023 to 2026 window. Focused safety guidance on bleomycin fitness assessment and toxicity management.	A single-topic good practice paper, not a disease pathway, and it does not supersede either older guideline.
US	NCCN Hodgkin Lymphoma v1.2026, published panel summary in JNCCN^[10]	US algorithms and category-of-evidence framing.	The algorithms themselves need NCCN access; only public metadata is cited here. The live site version string could not be confirmed on 2 August 2026 — check before quoting a version number.
US	NCI PDQ, adult and childhood Hodgkin lymphoma^[53]^[54]	Open, frequently revised evidence synthesis, including paediatric recurrence and late effects.	US-oriented and not an access document. PDQ pages are revised continuously — record the revision date you read.
Transplant	ASTCT 2026^[42] and EBMT 2026^[43]	Current transplant indications, timing and handling of novel agents around transplantation.	Transplant-specific and adult-focused; not complete disease guidelines.
Japan	JSH practical guidelines, 2023 edition published 2025^[55]	A credible Asian comparator for adult diagnosis and treatment.	It is the 2023 edition published in 2025 — do not call it the "2025 guideline". Publisher access may be restricted.
Australia	eviQ Hodgkin lymphoma protocols^[56]	Open protocol-level comparison and supportive care detail.	Australian governance and access context. The landing page is a hub; individual protocols sit one level down and some content needs registration.
Canada	BC Cancer lymphoma and myeloma protocols^[57]	Public regimen and protocol comparator.	Provincial practice, not a global standard. The protocol index page had a server-side redirect problem on 2 August 2026; individual protocol PDFs were reachable.

Evidence is not a licence, and a licence is not funding

Three separate questions, three separate answers, checked separately every time:

Does it work? Answered by trials and guidelines. S1826 answers this for nivolumab plus AVD.
Is it authorised? Answered by the MHRA, EMA or FDA label for that exact indication and age range.
Will the NHS pay for it, for this patient, today? Answered by the relevant NICE technology appraisal, any NHS England commissioning policy, and the local formulary or Blueteq route. Access outside England needs separate verification.

A terminated appraisal such as TA594 is none of these three: it records that no submission was made.^[50]

23

Evidence method, uncertainty and unresolved items

How this page was built

Four separated layers

Efficacy and safety evidence — randomised trials first, then prospective single-arm studies and cohorts. Study design is labelled on every treatment card.
Professional guidance — EHA 2026 as the current adult backbone, cross-checked against BSH for UK practice, ESMO 2025 and NCCN v1.2026; paediatric protocol evidence and NCI PDQ for children and TYA; ASTCT and EBMT for transplant questions.
Regulatory status — MHRA, EMA and FDA labels. A licence is not a recommendation.
UK access — NICE technology appraisals and NHS England commissioning policies, read on 2 August 2026.

Deliberate omissions

No manufactured GRADE labels. Where a source does not formally grade a recommendation, the study design and its limitations are described instead.
No doses, cycle counts or radiotherapy prescriptions. Regimens are named; the numbers come from a validated protocol.
No Deauville cut-off is asserted for a trial whose report does not state one.
No approval, review or pharmacy-verification claim. This page has had none and does not display one.

Areas of real disagreement

Early-stage radiotherapy omission. Less radiation against more relapses. Three randomised trials point the same way on relapse; none settles the value judgement.
First-line choice in advanced disease. PET-directed ABVD/AVD, brentuximab vedotin plus AVD, nivolumab plus AVD, PET-directed escalated BEACOPP and BrECADD are not interchangeable and are not equally available.
PET-positive escalation. Thresholds and escalation regimens are trial-specific and cannot be mixed.
Older adults. Thin randomised evidence, disproportionate toxicity, and most first-line trials capped at 60 years.
First salvage. Checkpoint-based and brentuximab-based regimens are highly active, but there is no randomised hierarchy across all salvage options.
Post-transplant consolidation after previous brentuximab vedotin. AETHERA largely predates routine earlier brentuximab exposure; extrapolation needs caution, and the England funding route differs from the trial indication.
Allogeneic transplantation after PD-1 blockade. Potentially curative, with an altered immune-complication profile that changes sequencing and technique.
TYA pathway selection. Paediatric and adult protocols overlap in age but differ in risk systems and late-effect assumptions.
NLPHL. Classification terminology and the balance between indolent-disease control and overtreatment are both still moving.
Resource-limited settings. PET, radiotherapy planning, novel agents and transplantation are not universally available; adaptations should be labelled as such rather than presented as equivalent evidence.

Unresolved items — recorded rather than guessed

Verify these against the primary source before clinical or teaching use

BSH bleomycin good practice paper. The full text was not readable from the open landing page on 2 August 2026. The exact position on who needs formal baseline respiratory investigation, and the thresholds for withholding or stopping bleomycin, must be read from Br J Haematol 2025;206(1):74–85 before being turned into local practice.
NHS England policy 2404 (brentuximab vedotin with bendamustine). The live PDF should be read in full. Reports of that document have circulated with an out-of-date NICE cross-reference and with a definition that does not match the drugs in the policy. Neither has been reproduced on this page. Take the eligibility criteria, the AND/OR grouping and the policy's own references from the current PDF only.
NICE index completeness. NICE's filtered guidance listings returned errors to automated access on 2 August 2026. The statement that no positive NICE recommendation exists for first-line nivolumab plus AVD is recorded as "none identified on this date", not as a definitive absence.
NICE TA524 funding route. The recommendation wording reads as routine commissioning and the appraisal arose from a Cancer Drugs Fund reconsideration of TA446. Confirm the current funding route before relying on it.
Whether TA967 formally replaces TA772 as distinct from replacing TA540. The TA967 overview page could not be read on 2 August 2026. The two appraisals are described here as covering separate groups because their prior-brentuximab conditions are mutually exclusive.
NCCN version number on the live site. The published JNCCN metadata for v1.2026 is solid; the website version string could not be confirmed.
Active UK paediatric protocol. No public Hodgkin-specific CCLG guideline was found. Confirm the current national protocol with the paediatric principal treatment centre.
Deauville cut-offs for RAPID, H10, HD17, RATHL, HD18, AHL2011 and HD21 are not stated in the published abstracts and were not inferred. Read the Methods sections before quoting a number.
Errata. Published errata exist for the ECHELON-1 primary report and for HD21. Check their content before quoting figures from those papers.

Corrected during preparation

The following were found to be wrong in the working evidence dossier and were corrected before this page was written: a EuroNet paediatric imaging-consensus DOI that is not registered anywhere and has been removed entirely; a non-existent DOI for the COG AHOD0431 report; a non-existent DOI for KEYNOTE-087; the Lugano classification year (2014, not 2013); the ESMO 2025 document title, which is "Lymphomas", not a Hodgkin-specific title; the JSH edition year; the BSH relapsed and refractory guideline year (2014, published online 2013); the BSH bleomycin paper citation (published online 2024, journal issue 2025, DOI 10.1111/bjh.19840); and the NHS England single-agent bendamustine policy, which is a negative policy and had been described as an access route.

Version history and governance — MHA-HL-2026-v1.0

Version	Date	Author	Change
v1.0	2 Aug 2026	Dr M Mohsin	First educational draft. Age-aware structure across children, TYA and adults, each split into newly diagnosed, first relapse or primary refractory, and multiply relapsed or refractory disease. Separate NLPHL pathway. Advanced-disease platform comparison. Transplant-intent salvage schematic. UK access separated from efficacy throughout, with NICE and NHS England wording read live on 2 August 2026. Unresolved items recorded rather than inferred.

Governance statement: this page is an educational resource authored by the clinical owner. No external review, pharmacy verification or publication authorisation has been sought, obtained or claimed. Any future clinical deployment would need its own governance decision. NICE and NHS England statements describe England only. Always verify current NICE guidance, NHS commissioning criteria, the Summary of Product Characteristics and local policy before prescribing. Dr Muhammad Mohsin is responsible for the educational content of this page.

24

References

Credibility tags: A1 society guideline or official access document A2 randomised trial B single-arm, phase I/II or observational C reference resource. All metadata confirmed against Crossref, Europe PMC or the issuing organisation on 2 August 2026 unless marked otherwise.

Guidance and classification

Eichenauer DA, André M, Borchmann P, et al. Hodgkin lymphoma: EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up. HemaSphere. 2026;10(6):e70422. doi:10.1002/hem3.70422. Open full text: PMC13288861. A1
Eyre TA, Cwynarski K, d'Amore F, et al. Lymphomas: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2025;36(11):1263–1284. doi:10.1016/j.annonc.2025.07.014. A1
Follows GA, Barrington SF, Bhuller KS, et al. Guideline for the first-line management of Classical Hodgkin Lymphoma — A British Society for Haematology guideline. Br J Haematol. 2022;197(5):558–572. doi:10.1111/bjh.18083. A1
Collins GP, Parker AN, Pocock C, et al. Guideline on the management of primary resistant and relapsed classical Hodgkin lymphoma. Br J Haematol. 2014;164(1):39–52; published online 2013. doi:10.1111/bjh.12582. A1
McKay P, Fielding P, Gallop-Evans E, et al. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol. 2016;172(1):32–43; published online 2015. doi:10.1111/bjh.13842. A1
Barrett A, Shah N, Chadwick A, et al. Assessment of fitness for bleomycin use and management of bleomycin pulmonary toxicity in patients with classical Hodgkin lymphoma: A British Society for Haematology Good Practice Paper. Br J Haematol. 2025;206(1):74–85; published online 6 November 2024. doi:10.1111/bjh.19840. A1
NICE NG47. Haematological cancers: improving outcomes. Published 25 May 2016. nice.org.uk/guidance/ng47. Service organisation only; contains no Hodgkin-specific treatment recommendations. A1
NICE NG12. Suspected cancer: recognition and referral. Published 23 June 2015; last updated 15 April 2026. nice.org.uk/guidance/ng12. A1
Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification. J Clin Oncol. 2014;32(27):3059–3067. doi:10.1200/JCO.2013.54.8800. Published 2014 despite the 2013 element in the DOI. A1
Advani RH, Kelsey CR, Armand P, et al. Hodgkin Lymphoma, Version 1.2026, NCCN Clinical Practice Guidelines In Oncology. J Natl Compr Canc Netw. 2026;24(2):41–60. doi:10.6004/jnccn.2026.0006. Algorithms require NCCN access and are not reproduced here. A1

Early-stage trials

Engert A, et al. Reduced Treatment Intensity in Patients with Early-Stage Hodgkin's Lymphoma (GHSG HD10). N Engl J Med. 2010;363(7):640–652. PMID 20818855. doi:10.1056/NEJMoa1000067. A2
Radford J, et al. Results of a Trial of PET-Directed Therapy for Early-Stage Hodgkin's Lymphoma (RAPID). N Engl J Med. 2015;372(17):1598–1607. PMID 25901426. doi:10.1056/NEJMoa1408648. A2
André MPE, et al. Early Positron Emission Tomography Response–Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol. 2017;35(16):1786–1794. PMID 28291393. doi:10.1200/JCO.2016.68.6394. A2
Fuchs M, et al. Positron Emission Tomography–Guided Treatment in Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. J Clin Oncol. 2019;37(31):2835–2845. PMID 31498753. doi:10.1200/JCO.19.00964. A2
Fuchs M, et al. Follow-up of the GHSG HD16 trial of PET-guided treatment in early-stage favorable Hodgkin lymphoma. Leukemia. 2024;38(1):160–167; published online 16 October 2023. PMID 37845285. doi:10.1038/s41375-023-02064-y. A2
Borchmann P, et al. PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021;22(2):223–234. PMID 33539742. doi:10.1016/S1470-2045(20)30601-X. A2

Advanced-stage trials

Johnson P, et al. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma (RATHL). N Engl J Med. 2016;374(25):2419–2429. PMID 27332902. doi:10.1056/NEJMoa1510093. A2
Borchmann P, et al. PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet. 2017;390(10114):2790–2802. PMID 29061295. doi:10.1016/S0140-6736(17)32134-7. A2
Casasnovas RO, et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019;20(2):202–215. PMID 30658935. doi:10.1016/S1470-2045(18)30784-8. A2
Connors JM, et al. Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin's Lymphoma (ECHELON-1). N Engl J Med. 2018;378(4):331–344. PMID 29224502. doi:10.1056/NEJMoa1708984. A published erratum exists; check it before quoting figures. A2
Ansell SM, et al. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma. N Engl J Med. 2022;387(4):310–320. PMID 35830649. doi:10.1056/NEJMoa2206125. Overall survival was the key secondary endpoint, not the primary endpoint. A2
Herrera AF, et al. Nivolumab plus AVD in Advanced-Stage Classic Hodgkin's Lymphoma (SWOG S1826). N Engl J Med. 2024;391(15):1379–1389. PMID 39413375. doi:10.1056/NEJMoa2405888. A2
Borchmann P, et al. Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial. Lancet. 2024;404(10450):341–352. PMID 38971175. doi:10.1016/S0140-6736(24)01315-1. A published erratum exists; check it before quoting figures. A2

Paediatric and AYA trials

Mauz-Körholz C, et al. Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study. Lancet Oncol. 2023;24(3):252–261. PMID 36858722. doi:10.1016/S1470-2045(23)00019-0. A2
Mauz-Körholz C, et al. Response-adapted omission of radiotherapy and comparison of consolidation chemotherapy in children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (EuroNet-PHL-C1). Lancet Oncol. 2022;23(1):125–137. PMID 34895479. doi:10.1016/S1470-2045(21)00470-8. A2
Castellino SM, et al. Brentuximab Vedotin with Chemotherapy in Pediatric High-Risk Hodgkin's Lymphoma (COG AHOD1331). N Engl J Med. 2022;387(18):1649–1660. PMID 36322844. doi:10.1056/NEJMoa2206660. A2
Keller FG, et al. Results of the AHOD0431 trial of response adapted therapy and a salvage strategy for limited stage, classical Hodgkin lymphoma: A report from the Children's Oncology Group. Cancer. 2018;124(15):3210–3219. PMID 29738613. doi:10.1002/cncr.31519. A2
Friedman DL, et al. Dose-Intensive Response-Based Chemotherapy and Radiation Therapy for Children and Adolescents With Newly Diagnosed Intermediate-Risk Hodgkin Lymphoma: A Report From the Children's Oncology Group Study AHOD0031. J Clin Oncol. 2014;32(32):3651–3658. PMID 25311218. doi:10.1200/JCO.2013.52.5410. Published 2014 despite the 2013 element in the DOI. A2
Daw S, Hasenclever D, Mascarin M, et al. Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. HemaSphere. 2020;4(1):e329. doi:10.1097/HS9.0000000000000329. A1

Relapsed and refractory evidence

Linch DC, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993;341(8852):1051–1054. PMID 8096958. doi:10.1016/0140-6736(93)92411-L. A2
Schmitz N, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. 2002;359(9323):2065–2071. PMID 12086759. doi:10.1016/S0140-6736(02)08938-9. A2
Younes A, et al. Results of a Pivotal Phase II Study of Brentuximab Vedotin for Patients With Relapsed or Refractory Hodgkin's Lymphoma. J Clin Oncol. 2012;30(18):2183–2189. PMID 22454421. doi:10.1200/JCO.2011.38.0410. B
Moskowitz CH, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385(9980):1853–1862. PMID 25796459. doi:10.1016/S0140-6736(15)60165-9. A2
Moskowitz CH, et al. Five-year PFS from the AETHERA trial of brentuximab vedotin for Hodgkin lymphoma at high risk of progression or relapse. Blood. 2018;132(25):2639–2642. PMID 30266774. doi:10.1182/blood-2018-07-861641. A2
Kuruvilla J, et al. Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study. Lancet Oncol. 2021;22(4):512–524. PMID 33721562. doi:10.1016/S1470-2045(21)00005-X. A2
Chen R, et al. Pembrolizumab in relapsed or refractory Hodgkin lymphoma: 2-year follow-up of KEYNOTE-087. Blood. 2019;134(14):1144–1153. PMID 31409671. doi:10.1182/blood.2019000324. B
Chen R, et al. Phase II Study of the Efficacy and Safety of Pembrolizumab for Relapsed/Refractory Classic Hodgkin Lymphoma (KEYNOTE-087 primary report). J Clin Oncol. 2017;35(19):2125–2132. PMID 28441111. doi:10.1200/JCO.2016.72.1316. B
Ansell SM, et al. Nivolumab for relapsed/refractory classical Hodgkin lymphoma: 5-year survival from the pivotal phase 2 CheckMate 205 study. Blood Adv. 2023;7(20):6266–6274. PMID 37530622. doi:10.1182/bloodadvances.2023010334. B
Moskowitz AJ, et al. Phase II Trial of Pembrolizumab Plus Gemcitabine, Vinorelbine, and Liposomal Doxorubicin as Second-Line Therapy for Relapsed or Refractory Classical Hodgkin Lymphoma. J Clin Oncol. 2021;39(28):3109–3117. PMID 34170745. doi:10.1200/JCO.21.01056. B
Advani RH, et al. Brentuximab vedotin in combination with nivolumab in relapsed or refractory Hodgkin lymphoma: 3-year study results. Blood. 2021;138(6):427–438. PMID 33827139. doi:10.1182/blood.2020009178. Published 2021 despite the 2020 element in the DOI. B
LaCasce AS, et al. Brentuximab vedotin plus bendamustine: a highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma. Blood. 2018;132(1):40–48. PMID 29703778. doi:10.1182/blood-2017-11-815183. B
Ahmed S, Kumar A, Carpenter P, et al. American Society of Transplantation and Cellular Therapy Clinical Practice Recommendations for Transplantation in Classical Hodgkin Lymphoma. Transplant Cell Ther. 2026;32(3):250–260. doi:10.1016/j.jtct.2025.12.944. A1
Bazarbachi A, Advani R, Ahmed S, et al. Autologous and allogeneic haematopoietic cell transplantation in adult patients with Hodgkin lymphoma: recommendations from the EBMT Practice Harmonisation and Guidelines Committee and Lymphoma Working Party. Lancet Haematol. 2026;13(7):e484–e493. doi:10.1016/S2352-3026(26)00102-X. A1

UK access documents

NICE TA1059. Brentuximab vedotin in combination for untreated stage 3 or 4 CD30-positive Hodgkin lymphoma. Published 7 May 2025. Updates and replaces TA594. nice.org.uk/guidance/ta1059. A1
NICE TA524. Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma. Published 13 June 2018; reviewed 8 July 2021. Replaces TA446. nice.org.uk/guidance/ta524. A1
NICE TA462. Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma. Published 26 July 2017; last updated January 2019. nice.org.uk/guidance/ta462. A1
NICE TA772. Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma after stem cell transplant or at least 2 previous therapies. Published 23 February 2022. Applies where brentuximab vedotin has not been given. nice.org.uk/guidance/ta772. A1
NICE TA967. Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma in people 3 years and over. Published 1 May 2024. Applies where brentuximab vedotin has already been given. nice.org.uk/guidance/ta967. A1
NICE TA540. Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma. Published 3 September 2018; last updated 1 May 2024. Recommendation 1.2 was updated and replaced by TA967. nice.org.uk/guidance/ta540. A1
NICE TA594. Brentuximab vedotin for untreated advanced Hodgkin lymphoma (terminated appraisal). NICE was unable to make a recommendation because no evidence submission was made. Historical; superseded by TA1059. nice.org.uk/guidance/ta594. A1
NHS England. Clinical commissioning policy: Combination brentuximab vedotin and bendamustine (BVB) for patients aged 8 years and above with relapsed or refractory classical Hodgkin lymphoma. Reference 2404, published 16 July 2026. england.nhs.uk. Read the live PDF for the exact criteria. A1
NHS England. Clinical Commissioning Policy Statement: Bendamustine for relapsed/refractory classical Hodgkin lymphoma (all ages). Reference 1828, document dated July 2020. Bendamustine is not recommended as a treatment option; criteria "not applicable". england.nhs.uk. A1

Reference resources

National Cancer Institute. Hodgkin Lymphoma Treatment (PDQ®) — Health Professional Version. cancer.gov. Revised continuously; record the revision date you read. C
National Cancer Institute. Childhood Hodgkin Lymphoma Treatment (PDQ®) — Health Professional Version. cancer.gov. C
Kusumoto S, Tomita A. JSH practical guidelines for hematological malignancies, 2023: II. Lymphoma 10. Hodgkin lymphoma (HL). Int J Hematol. 2025;122(6):781–802. doi:10.1007/s12185-025-04079-w. The 2023 edition, published 2025. C
eviQ. Hodgkin lymphoma protocols. Cancer Institute NSW. eviq.org.au. Australian governance and access context. C
BC Cancer. Lymphoma and myeloma chemotherapy protocols. bccancer.bc.ca. Provincial practice. The index page had a server-side redirect problem on 2 August 2026; individual protocol PDFs were reachable. C

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How to cite this page

Copy one of the formats below if you are citing this guideline in a presentation, teaching pack, audit write-up or letter. Update the access year if you are reading this later.

APA

Mohsin, M. (2026). Hodgkin Lymphoma — Evidence-Based Educational Guideline (Version 1.0). Mohsin Haematology Academy. https://mohsinhaemacademy.com/guidelines/hodgkin-lymphoma/

Vancouver

Mohsin M. Hodgkin Lymphoma — Evidence-Based Educational Guideline. Version 1.0. Mohsin Haematology Academy; 2026. Available from: https://mohsinhaemacademy.com/guidelines/hodgkin-lymphoma/

BibTeX

@misc{mohsin_hl_2026,
  author  = {Mohsin, Muhammad},
  title   = {Hodgkin Lymphoma --- Evidence-Based Educational Guideline},
  edition = {1.0},
  year    = {2026},
  url     = {https://mohsinhaemacademy.com/guidelines/hodgkin-lymphoma/},
  note    = {Mohsin Haematology Academy. Educational draft, 2 August 2026. Evidence and access verified 2 August 2026.}
}

Citation etiquette: when this page informs a clinical discussion, cite the primary EHA, BSH, NICE, NHS England and trial sources listed above as well. This page is a synthesis, not a primary source.

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