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Lymphatic system

Hodgkin lymphoma

How Hodgkin lymphoma care moved from an 1832 case series to curative radiotherapy, combination chemotherapy and response-adapted treatment.

5-year relative survival · United States, SEER 8 registries

70.46%→94.17%

1975 (observed value; first year in the table) to 2018 (observed value; last observed year in the table). Read these with the caveats under “Then and now”.Source

28 milestones, by decade

  • In US registry data on the SEER Cancer Stat Facts page, the age-adjusted death rate from Hodgkin lymphoma fell from 1.31 per 100,000 in 1975 to 0.21 in 2024, while the age-adjusted rate of new cases in the SEER 8 column stayed between 2.28 and 3.10 per 100,000 over 1975-2023. Observed five-year relative survival in the SEER 8 series was 70.46% for 1975 and 94.17% for 2018 (the page does not say whether the year is the year of diagnosis). The page does not say how much of the change reflects treatment, stage or age mix, or staging methods.
  • Thomas Hodgkin's 1832 paper reported seven patients: six of his own and one given to him by Robert Carswell, whose colored pictures accompanied Hodgkin's presentation. Modern histology and immunostaining of specimens preserved at Guy's Hospital supported some of the cases as Hodgkin disease by present-day criteria but also showed that at least one was a non-Hodgkin lymphoma. The eponym entered the medical literature through repeated attempts by Samuel Wilks to credit Hodgkin with priority.
  • Vera Peters's 1950 review of 113 histologically proven cases treated with radiotherapy in Toronto grouped patients by extent of disease and suggested that cure might be possible in stage I, although she did not make that claim in the paper. According to a later account, a survey of the eight editions, from 1950 to 1977, of a widely used internal medicine textbook (Harrison's Principles of Internal Medicine) found no mention of the curability of Hodgkin disease until the 1970s.

Evidence current to October 2026 · Checked against primary sources to the extent possible

A guided tour of 11 milestones. You can pause or step through it yourself.

Filter milestonesshowing all 28
Treatment type
Setting

Anatomists & surgeons

  1. 1832 · Origin · UnderstandingHodgkin describes enlarged lymph nodes and spleen (1832)In 1832 the London pathologist Thomas Hodgkin described seven people whose lymph nodes and spleen were enlarged, based on what he found at autopsy. Later reviews of his cases disagree on how many were Hodgkin lymphoma; at least one was a different lymphoma, so the disease carrying his name was only part of what he reported.Hodgkin's paper in Med Chir Trans, read to the Medical and Chirurgical Society on 10 and 24 January 1832, gave gross autopsy findings in seven patients with enlarged lymph nodes and spleen: six his own, one from Carswell. Later examination of preserved specimens found Hodgkin lymphoma in some and at least one non-Hodgkin lymphoma. On treatment he wrote that he had nothing to offer; most patients had reached hospital at an advanced stage.
  2. 1865 · Origin · UnderstandingWilks attaches Hodgkin's name to the disease (1865)In 1865 the Guy's Hospital physician Samuel Wilks published fifteen cases of enlarged lymph glands and spleen under a title that gave the condition as Hodgkin's disease, noting that Hodgkin had been first to draw attention to it more than thirty years before. The name has stayed in use; Wilks also favoured the term anaemia lymphatica.Wilks's paper in Guy's Hospital Reports (vol. XI, pp. 56-67), 'Cases of enlargement of the lymphatic glands and spleen (or Hodgkin's disease) with remarks', reports fifteen cases, reviews Hodgkin's 1832 cases and says Hodgkin was first, as far as Wilks knew, to call attention to the disease. Stone (2005) cites it as the first use of the name Hodgkin's disease. Wilks preferred 'anaemia' to 'leucocythaemia lymphatica'.

The age of rays

  1. 1898 · Understanding · UnderstandingSternberg and Reed describe the characteristic giant cellIn 1898 Carl Sternberg in Vienna and, in 1902, Dorothy Reed in Baltimore described large cells with strongly stained nuclei, some with several nuclei, in the lymph nodes of people with this disease. They became known as Reed-Sternberg cells. Sternberg read his cases as a peculiar form of tuberculosis; Reed concluded that tuberculosis had no direct relation to the disease.Sternberg (Z Heilkd, 1898) described large cells with intensely stained single or multiple nuclei in cases clinically labelled pseudoleukaemia (15 detailed cases from 18 available; tuberculosis demonstrated in ten) and read the process as a peculiar tuberculosis of the lymphatic apparatus. Reed (Johns Hopkins Hosp Rep, 1902) described similar giant cells in eight cases, judged them characteristic, and concluded that microscopy suffices for diagnosis and that tuberculosis is not directly related.

Chemotherapy

  1. 1950 · Treatment · Radiation⚑ needs reviewPeters links stage to survival after radiotherapy (1950)In 1950 Vera Peters in Toronto reported survival for 113 histologically proven cases of Hodgkin disease treated with radiotherapy, grouped by how far the disease had spread. Those with the least spread did best. A historian writes that her figures suggested cure might be possible; she did not claim it, and she later recalled that acceptance took about ten years.Peters (Toronto, 1950), as described by Cowan 2008: 113 histologically proven cases treated with radiotherapy and grouped into three stages by extent of disease. Stage I: 5-year survival 88%, 10-year 79%, median survival over 11.6 years (stage II over 7.8 years, stage III 1.9 years). Per Cowan, Peters did not claim cure in this paper. Figures are from Cowan's account; the 1950 paper was not opened.
  2. 1962 · Treatment · RadiationKaplan: radical radiotherapy and the Stanford trialsIn 1962 Henry Kaplan of Stanford published a paper on radical radiotherapy for Hodgkin disease that had not spread widely. That same year Stanford began a long series of randomised trials. Over twenty-two years they involved more than eight hundred people, and the authors reported steady improvement in remission and survival.Kaplan 1962: title 'The radical radiotherapy of regionally localized Hodgkin's disease' (no abstract; text not read). Stanford randomised trials, initiated 1962 (Rosenberg and Kaplan 1985): 132 patients with clinical stage I, II and III disease enrolled on radiation trials from 1962 to 1967; more than 800 patients over 22 years; remission rate, duration and survival progressively improved across protocol eras. No arm comparisons extracted.
  3. 1970 · Treatment · ChemotherapyMOPP: combination chemotherapy for advanced Hodgkin diseaseIn 1970 researchers at the US National Cancer Institute reported a four-drug combination, later called MOPP, for advanced Hodgkin disease. Long-term follow-up showed that most people reached complete remission and about two in three of them stayed free of disease for over ten years. The authors concluded the disease appeared curable by chemotherapy.Uncontrolled single-institution series of MOPP (mechlorethamine, vincristine, procarbazine, prednisone) in advanced Hodgkin disease; the 1970 report has no PubMed abstract. 1980 analysis of 198 patients: 80% complete remission, 68% of complete responders disease-free beyond 10 years. 1986 update, median follow-up 14 years: of 188 patients with confirmed Hodgkin disease, 157 (84%) achieved complete response and 101 (66%) stayed disease-free beyond 10 years.
  4. 1971 · Understanding · UnderstandingAnn Arbor staging classification for Hodgkin's diseaseIn 1971 a committee published a staging classification for Hodgkin's disease that grouped patients by how far the disease had spread. It let doctors choose treatment by stage and compare results between centres. Later meetings added scans and bulk, and its terminology is still used in today's lymphoma staging.The 1971 report of the Committee on Hodgkin's Disease Staging Classification (Carbone et al) is cited by Munir et al (2023) as the origin of the Ann Arbor classification, a mainly anatomical system. The Cotswolds meeting (Lister 1989) kept the structure and added CT, an X suffix for bulk over 10 cm and a CR(u) response category. The Lugano classification (Cheson 2014) modified Ann Arbor terminology, kept A or B only for Hodgkin lymphoma and added PET-CT for FDG-avid disease.
  5. 1975 · Treatment · ChemotherapyABVD versus MOPP: preliminary randomised results (Bonadonna)In 1975 Bonadonna and colleagues reported early results from a study in which people with advanced Hodgkin disease were randomly given either MOPP or a new four-drug combination, ABVD. About three in four of the people evaluated in each group reached complete remission, and switching to the other regimen after a failure showed no sign of cross-resistance.Preliminary report of a controlled study randomising ABVD (six cycles) versus MOPP in advanced Hodgkin's disease: 60 patients entered, 45 evaluable for remission induction (MOPP 25, ABVD 20). Complete remission 76% with MOPP and 75% with ABVD, with no difference by stage, histologic type or prior irradiation. Crossover for progression or relapse showed no cross-resistance. The authors note that the lack of long-term follow-up limits comparison.

Molecular origins

  1. 1992 · Treatment · ChemotherapyCALGB: ABVD and MOPP/ABVD versus MOPP in advanced diseaseIn a US trial of 361 people with advanced Hodgkin disease, MOPP, ABVD, and the two alternating were compared. Complete remission was reached by 67 in 100 on MOPP, 82 on ABVD and 83 on the alternating regimen. Five-year failure-free survival was 50, 61 and 65 in 100 respectively.Randomised multicentre trial (CALGB 8251), 361 eligible patients with advanced Hodgkin's disease: MOPP (123), MOPP alternating with ABVD (123), ABVD (115). Complete response 67% with MOPP, 83% with MOPP-ABVD, 82% with ABVD (P=0.006, MOPP versus the other two). Five-year failure-free survival 50%, 65%, 61%; overall survival 66%, 75%, 73% (P=0.28, MOPP versus doxorubicin regimens). ABVD was less myelotoxic than MOPP.
  2. 1993 · Treatment · ChemotherapyHigh-dose BEAM with transplant for relapsed Hodgkin's diseaseTwo randomised trials tested high-dose chemotherapy plus a transplant for people whose Hodgkin disease had returned. A British trial of 40 people and a German-European trial of 161 both found better disease control with transplant. In the larger, among those responding to initial chemotherapy, 55 in 100 versus 34 in 100 had no treatment failure at three years.Two randomised trials of high-dose BEAM with transplant. BNLI (40 patients, relapsed or resistant disease; closed early, 66 intended): BEAM plus ABMT versus mini-BEAM; event-free survival P=0.025 and progression-free survival P=0.005 favoured BEAM plus ABMT; deaths 5 versus 9 (P=0.318). GHSG/EBMT (161 randomised, chemosensitive relapse, per protocol): 3-year FFTF 55% with BEAM-HSCT versus 34% with Dexa-BEAM (P=0.019); overall survival did not differ significantly.
  3. 1994 · Understanding · UnderstandingSingle-cell studies indicate B-cell origin of Reed-Sternberg cellsIn 1994 German researchers picked individual Hodgkin and Reed-Sternberg cells out of tissue sections from three people and found, in each, a single shared antibody-gene pattern. This pointed to a clone of B cells, a question about the cells' origin that had been open for decades. A 1996 study extended it to nine of ten cases.Kuppers et al (PNAS 1994) micromanipulated HRS cells from three cases, one of each of three subtypes, and amplified immunoglobulin V genes by PCR: each case showed a single clonal VH rearrangement. Somatic mutation with intraclonal diversity in the lymphocyte-predominant case indicated germinal-centre B-cell origin; the mixed-cellularity case showed only nonfunctional rearrangements. Kanzler et al (1996) found clonally related rearrangements in nine of 10 patients.
  4. 1994 · Understanding · Supportive care⚑ needs reviewSecond cancers after treatment for Hodgkin lymphomaLong-term follow-up of people treated for Hodgkin lymphoma in the Netherlands from 1966 to 1986 found second cancers, including leukemia, lymphoma, lung and breast cancer, were more common than expected, with risks that depended on the treatment given. Later studies followed survivors for up to 40 years.Dutch cohort of 1939 patients treated 1966 to 1986: 146 second cancers versus 41.9 expected (relative risk 3.5, 95% CI 2.9 to 4.1); 20-year actuarial risk 20%. Leukemia risk was linked to mechlorethamine-procarbazine cycles. A later cohort of 3905 survivors treated 1965 to 2000: SIR 4.6 (95% CI 4.3 to 4.9); 40-year cumulative incidence of a second cancer 48.5%.

Targeted therapy

  1. 2003 · Treatment · ChemotherapyBEACOPP (GHSG HD9) versus COPP-ABVD in advanced diseaseA German trial of 1,201 people aged 15 to 65 with advanced Hodgkin disease compared three chemotherapy plans. After five years, 87 in 100 people on increased-dose BEACOPP were free of treatment failure, compared with 69 in 100 on COPP-ABVD, and 91 versus 83 in 100 were alive. Ten-year follow-up showed the same pattern.GHSG HD9: 1195 evaluable patients aged 15 to 65 with unfavorable stage IIB/IIIA or stage IIIB/IV disease, randomised to eight cycles of COPP-ABVD, BEACOPP or increased-dose BEACOPP. Five-year FFTF 69%, 76%, 87%; OS 83%, 88%, 91% (increased-dose BEACOPP versus COPP-ABVD: FFTF P<0.001, OS P=0.002). Ten-year update (median follow-up 111 months): FFTF 64%, 70%, 82%; OS 75%, 80%, 86%.
  2. 2003 · Understanding · Supportive care⚑ needs reviewCardiovascular late effects after Hodgkin treatmentA Dutch study of people treated for Hodgkin lymphoma before age 41 found deaths from heart disease and from second solid tumours about six times as common as in the general population. Later Dutch studies showed that chest radiotherapy and anthracycline chemotherapy each raised heart-disease risk, with radiation risk rising with the dose to the heart.Aleman 2003 (1261 patients treated before age 41, 1965 to 1987; median follow-up 17.8 years): relative risk of death from cardiovascular disease 6.3, from solid tumours 6.6. van Nimwegen 2015 (2524 patients, treated 1965 to 1995): 40-year cumulative incidence of cardiovascular disease 50% (95% CI 47% to 52%); mediastinal radiotherapy raised coronary heart disease risk (HR 2.7, 95% CI 2.0 to 3.7). van Nimwegen 2016 (nested case-control): excess relative risk 7.4% per Gy mean heart dose.
  3. 2007 · Understanding · UnderstandingInterim PET predicts outcome in advanced Hodgkin lymphomaIn a 2007 Italian-Danish study of 260 people with newly diagnosed Hodgkin lymphoma, a PET scan after two cycles of ABVD chemotherapy separated outcomes: about 95 in 100 with a negative scan were free of progression at two years, against about 13 in 100 with a positive scan. Treatment was not changed on the result.Prospective Italian-Danish cohort of 260 newly diagnosed patients (190 stages IIB through IVB; 70 stage IIA with adverse factors) treated with ABVD; PET after two cycles (PET-2) with no treatment change allowed. At median follow-up 2.19 years, 2-year progression-free survival was 12.8% for PET-2-positive and 95.0% for PET-2-negative patients (P < .0001); in multivariate analyses only PET-2 was significant.
  4. 2010 · De-escalation · ChemotherapyHD10: fewer cycles and lower dose in early favourable HLIn the German HD10 trial, 1370 people with early-stage Hodgkin lymphoma and a favourable outlook were given four or two cycles of ABVD, then radiotherapy at 30 or 20 gray. Neither the chemotherapy schedules nor the radiation doses differed significantly, and the authors judged two cycles plus 20 gray as effective as, and less toxic than, four plus 30.GHSG HD10 (Engert 2010): 1370 patients, early-stage favourable HL, randomised to 4 or 2 cycles of ABVD then 30 or 20 Gy involved-field radiotherapy. Primary endpoint FFTF. 5-year FFTF 93.0% (95% CI 90.5-94.8) with 4 cycles vs 91.1% (88.3-93.2) with 2 (P=0.39); OS P=0.61. Radiation dose 20 vs 30 Gy: FFTF P=1.00, OS P=0.61. Toxicity highest with 4 cycles plus 30 Gy.

Immunotherapy

  1. 2011 · Treatment · Antibody–drug conjugateBrentuximab vedotin approved for relapsed Hodgkin lymphomaIn 2011 the US regulator gave accelerated approval to brentuximab vedotin, a CD30-targeted antibody-drug conjugate, for Hodgkin lymphoma that returned after a stem-cell transplant, or after two chemotherapy regimens in people unable to have one. In the pivotal post-transplant study, three in four people had their cancer shrink and about one in three had no detectable disease.FDA accelerated approval, 19 August 2011: Hodgkin lymphoma after failure of ASCT, or after at least two multi-agent regimens in non-candidates. Pivotal single-arm phase 2 after ASCT (n=102; 1.8 mg/kg every 3 weeks): ORR 75%, complete remission 34%, median PFS 5.6 months. Phase 1 (n=45): maximum tolerated dose 1.8 mg/kg every 3 weeks; 6 of 12 patients at that dose responded.
  2. 2014 · De-escalation · RadiationEORTC H10: PET-guided omission of radiotherapy testedIn EORTC H10, people with early-stage Hodgkin lymphoma had a PET scan after two cycles of ABVD. A planned interim analysis found more early progressions when radiotherapy was left out after a negative scan, and the monitoring committee advised stopping randomisation to omission. The final report could not show that ABVD alone was no worse.EORTC/LYSA/FIL H10. Interim (Raemaekers 2014, 1,137 analysed): early PET negative in 85.8% (favourable) and 74.8% (unfavourable); events, standard vs experimental: favourable 1 vs 9, unfavourable 7 vs 16; committee advised stopping random assignment. Final (André 2017, 1950 randomised): ePET-negative 5-year PFS, ABVD + INRT vs ABVD only, 99.0% vs 87.1% (favourable; HR 15.8) and 92.1% vs 89.6% (unfavourable; HR 1.45); noninferiority not shown.
  3. 2014 · Treatment · ImmunotherapyPD-1 blockade for relapsed Hodgkin lymphomaIn heavily treated people whose Hodgkin lymphoma had come back, antibodies that block the PD-1 immune checkpoint shrank the cancer in about two in three people in the larger studies, and in 87 in 100 in the first small study of 23. These were single-group studies with no comparison arm.Single-arm studies in relapsed or refractory classic HL. Nivolumab first report (n=23): ORR 87%. CheckMate 205 (n=243, median follow-up 18 months): ORR 69% (95% CI 63 to 75), median DOR 16.6 months, median PFS 14.7 months. KEYNOTE-087, pembrolizumab (n=210): ORR 69.0% (95% CI 62.3 to 75.2), complete response 22.4%. FDA accelerated approvals: nivolumab 17 May 2016, pembrolizumab 14 March 2017.
  4. 2015 · De-escalation · RadiationRAPID: omitting radiotherapy after a negative PETIn the RAPID trial, people with early-stage Hodgkin lymphoma and a negative PET scan after three cycles of ABVD were randomly given radiotherapy or no further treatment. About ninety-five in a hundred were alive without progression at three years with radiotherapy and about ninety-one without. The trial did not show that stopping was no worse.RAPID (Radford 2015): 602 patients with stage IA/IIA HL received 3 cycles of ABVD; 426 of 571 scanned (74.6%) were PET-negative, and 420 were randomised to involved-field radiotherapy (n=209) or no further therapy (n=211). Median follow-up 60 months. 3-year PFS 94.6% (95% CI 91.5-97.7) vs 90.8% (86.9-94.8); difference -3.8 percentage points (95% CI -8.8 to 1.3), margin 7 points. Noninferiority not shown.
  5. 2015 · Treatment · Antibody–drug conjugateAETHERA: brentuximab vedotin consolidation after ASCTAfter a stem-cell transplant for Hodgkin lymphoma that had returned or not responded to first treatment, people at higher risk of further progression were given brentuximab vedotin or placebo for up to 16 cycles. The brentuximab group stayed free of progression longer: a median of about 43 months compared with 24 months.Double-blind phase 3 (329 randomised), unfavourable-risk relapsed or primary refractory classic HL after ASCT: brentuximab vedotin 1.8 mg/kg or placebo every 3 weeks for 16 cycles. PFS by independent review: HR 0.57 (95% CI 0.40 to 0.81; P=0.0013); median 42.9 versus 24.1 months. Peripheral sensory neuropathy 56% versus 16%.
  6. 2016 · De-escalation · ChemotherapyRATHL: dropping bleomycin after a negative interim PETIn a trial registering 1,214 adults with advanced Hodgkin lymphoma, a PET scan after two ABVD cycles was negative in about five in six of those scanned. They were randomly assigned to keep or drop bleomycin. Three-year progression-free survival was about 86 in 100 with bleomycin and 84 without; respiratory side effects were more severe with bleomycin.Randomised trial: 1214 registered; 937 of 1119 scanned patients (83.7%) were PET-negative after two ABVD cycles and randomised to continue ABVD or omit bleomycin (AVD). Median follow-up 41 months: 3-year PFS 85.7% with ABVD versus 84.4% with AVD, difference 1.6 percentage points (95% CI -3.2 to 5.3); the authors state this fell just short of the 5-point non-inferiority margin. Respiratory adverse events were more severe with ABVD.
  7. 2017 · De-escalation · ChemotherapyHD18: PET-2-guided cycles of escalated BEACOPPIn a German trial of people with advanced Hodgkin lymphoma, a PET scan after two cycles of intensive chemotherapy (eBEACOPP) guided further treatment. Among people with a negative scan, four cycles in total gave similar five-year results to six or eight, about 92 and 91 in 100 free of progression, with fewer severe infections and organ problems.GHSG HD18, open-label phase 3 (2101 recruited), PET-2-guided eBEACOPP. PET-2-negative cohort (non-inferiority, 6% margin, per protocol): 5-year PFS 92.2% with 4 cycles versus 90.8% with standard 8 or 6 cycles (difference 1.4%, 95% CI -2.7 to 5.4); severe infections 8% versus 15%. PET-2-positive cohort (434 randomised): 5-year PFS 89.7% with eBEACOPP versus 88.1% with rituximab added (P=0.46).
  8. 2017 · Treatment · Antibody–drug conjugateECHELON-1: brentuximab vedotin plus AVD vs ABVDIn people with newly diagnosed advanced Hodgkin lymphoma, a regimen with the antibody-drug conjugate brentuximab vedotin in place of bleomycin lowered the chance of progression, death or an incomplete response needing further treatment at two years. A later report found fewer deaths at six years. Nerve damage and low white-cell counts were more common.Open-label phase 3, stage III or IV classic HL (n=1334): A+AVD versus ABVD. Primary endpoint, independently reviewed modified PFS: 2-year 82.1% versus 77.2% (HR 0.77, 95% CI 0.60 to 0.98; P=0.04). Later report, median follow-up 73.0 months: 6-year OS 93.9% versus 89.4% (HR 0.59, 95% CI 0.40 to 0.88; P=0.009). Peripheral neuropathy 67% versus 43%; primary G-CSF prophylaxis was recommended with A+AVD.
  9. 2019 · De-escalation · RadiationGHSG HD16 and HD17: PET-guided radiotherapy in early stagesTwo trials of the German Hodgkin Study Group tested leaving out radiotherapy after a negative PET scan. In early favourable disease (HD16), progression-free survival was lower without radiotherapy, and the authors said radiotherapy cannot be omitted without clinically relevant loss of control. In early unfavourable disease (HD17), after a different chemotherapy sequence, omission was judged possible.HD16 (Fuchs 2019): PET-2-negative, per-protocol (628), 5-year PFS 93.4% with CMT vs 86.1% with ABVD alone (HR 1.78, 95% CI 1.02-3.12); 2024 follow-up, median 64 months: HR 2.05 (1.20-3.51). HD17 (Borchmann 2021): 1100 patients, 2 eBEACOPP + 2 ABVD, 5-year PFS 97.3% standard vs 95.1% PET4-guided; difference 2.2% (95% CI -0.9 to 5.3), margin 8%. Different risk groups and PET rules.

Precision & engineered

  1. 2022 · Treatment · Antibody–drug conjugateAHOD1331: brentuximab vedotin in pediatric high-risk HLIn children, adolescents and young adults aged 2 to 21 with high-risk Hodgkin lymphoma, swapping bleomycin for brentuximab vedotin in standard chemotherapy raised the share free of relapse, progression, a second cancer or death at three years from about 83 in 100 to about 92 in 100, with similar toxic effects reported.Open-label phase 3 (600 enrolled, 587 eligible), ages 2 to 21 years, stage IIB with bulk or stage IIIB, IVA or IVB. Brentuximab vedotin with doxorubicin, vincristine, etoposide, prednisone and cyclophosphamide versus a bleomycin-containing standard regimen, five cycles. 3-year EFS 92.1% versus 82.5% (HR 0.41, 95% CI 0.25 to 0.67; P<0.001); median follow-up 42.1 months. 3-year OS 99.3% versus 98.5%.
  2. 2024 · Treatment · ImmunotherapyS1826: nivolumab plus AVD versus BV plus AVDIn people aged 12 and older with newly diagnosed advanced Hodgkin lymphoma, nivolumab (a PD-1 checkpoint antibody) plus chemotherapy was compared with brentuximab vedotin plus the same chemotherapy. At two years about 92 in 100 people on the nivolumab regimen had no progression or death, compared with 83 in 100 on the other.Phase 3 (994 randomised; 970 in ITT efficacy population), stage III or IV classic HL, age 12 years or older: N+AVD versus BV+AVD, primary endpoint PFS. Second interim analysis (median follow-up 12.1 months): HR 0.48 (99% CI 0.27 to 0.87; P=0.001). Repeated analysis (median follow-up 2.1 years): 2-year PFS 92% versus 83%, HR 0.45 (95% CI 0.30 to 0.65).
  3. 2024 · Treatment · Antibody–drug conjugateHD21: BrECADD versus escalated BEACOPPFor adults up to 60 with advanced Hodgkin lymphoma, a PET-guided regimen containing brentuximab vedotin (BrECADD) caused fewer serious treatment-related problems than escalated BEACOPP (42 in 100 versus 59 in 100). Disease control was at least as good: about 94 in 100 versus 91 in 100 were free of progression at four years.Open-label phase 3, adults aged 60 years or younger with advanced-stage classic HL (1482 in ITT): PET-guided BrECADD versus eBEACOPP. Treatment-related morbidity 42% versus 59% (RR 0.72, 95% CI 0.65 to 0.80; P<0.0001). Median follow-up 48 months: PFS HR 0.66 (95% CI 0.45 to 0.97; P=0.035); 4-year PFS 94.3% versus 90.9%; 4-year OS 98.6% versus 98.2%.

Then and now

  • 5-year relative survival · United States, SEER 8 registries

    • 70.46%

      1975 (observed value; first year in the table)

    People with Hodgkin lymphoma, all races, both sexes (chart note); SEER 8 five-year relative survival series, 1975-2018, on the SEER Cancer Stat Facts Hodgkin lymphoma page. Age range, histologic subtype and stage mix are not stated for this series.

    Relative survival excludes deaths from other causes. 'Observed' is the table's label for the actual yearly value, as opposed to the modelled trend value in the adjacent column (71.64% for 1975). The table column is headed 'Year' and the chart is titled 'SEER 8 5-Year Relative Survival Percent from 1975-2018'; neither labels the year as year of diagnosis. SEER 8 is the grouping of eight registries available from 1975 (SEER registry-groupings page), and single-year values fluctuate (for example 69.05% in 1979 and 75.22% in 1980 in the same series). The page does not say how much of the change reflects treatment, changes in staging methods or stage mix, or age mix. Compare only with other values from the same SEER 8 series, and read them beside the death-rate values.

    Source

  • 5-year relative survival · United States, SEER 8 registries

    • 81.1%

      1990 (observed value)

    People with Hodgkin lymphoma, all races, both sexes (chart note); SEER 8 five-year relative survival series, 1975-2018, on the SEER Cancer Stat Facts Hodgkin lymphoma page. Age range, histologic subtype and stage mix are not stated for this series.

    Relative survival excludes deaths from other causes. 'Observed' is the table's label for the actual yearly value, as opposed to the modelled trend value in the adjacent column (81.12% for 1990). The table column is headed 'Year' and the chart is titled 'SEER 8 5-Year Relative Survival Percent from 1975-2018'; neither labels the year as year of diagnosis. SEER 8 is the grouping of eight registries available from 1975 (SEER registry-groupings page), and single-year values fluctuate (for example 69.05% in 1979 and 75.22% in 1980 in the same series). The page does not say how much of the change reflects treatment, changes in staging methods or stage mix, or age mix. Compare only with other values from the same SEER 8 series, and read them beside the death-rate values.

    Source

  • 5-year relative survival · United States, SEER 8 registries

    • 85.84%

      2000 (observed value)

    People with Hodgkin lymphoma, all races, both sexes (chart note); SEER 8 five-year relative survival series, 1975-2018, on the SEER Cancer Stat Facts Hodgkin lymphoma page. Age range, histologic subtype and stage mix are not stated for this series.

    Relative survival excludes deaths from other causes. 'Observed' is the table's label for the actual yearly value, as opposed to the modelled trend value in the adjacent column (85.78% for 2000). The table column is headed 'Year' and the chart is titled 'SEER 8 5-Year Relative Survival Percent from 1975-2018'; neither labels the year as year of diagnosis. SEER 8 is the grouping of eight registries available from 1975 (SEER registry-groupings page), and single-year values fluctuate (for example 69.05% in 1979 and 75.22% in 1980 in the same series). The page does not say how much of the change reflects treatment, changes in staging methods or stage mix, or age mix. Compare only with other values from the same SEER 8 series, and read them beside the death-rate values.

    Source

  • 5-year relative survival · United States, SEER 8 registries

    • 88.01%

      2010 (observed value)

    People with Hodgkin lymphoma, all races, both sexes (chart note); SEER 8 five-year relative survival series, 1975-2018, on the SEER Cancer Stat Facts Hodgkin lymphoma page. Age range, histologic subtype and stage mix are not stated for this series.

    Relative survival excludes deaths from other causes. 'Observed' is the table's label for the actual yearly value, as opposed to the modelled trend value in the adjacent column (89.36% for 2010). The table column is headed 'Year' and the chart is titled 'SEER 8 5-Year Relative Survival Percent from 1975-2018'; neither labels the year as year of diagnosis. SEER 8 is the grouping of eight registries available from 1975 (SEER registry-groupings page), and single-year values fluctuate (for example 69.05% in 1979 and 75.22% in 1980 in the same series). The page does not say how much of the change reflects treatment, changes in staging methods or stage mix, or age mix. Compare only with other values from the same SEER 8 series, and read them beside the death-rate values.

    Source

  • 5-year relative survival · United States, SEER 8 registries

    • 94.17%

      2018 (observed value; last observed year in the table)

    People with Hodgkin lymphoma, all races, both sexes (chart note); SEER 8 five-year relative survival series, 1975-2018, on the SEER Cancer Stat Facts Hodgkin lymphoma page. Age range, histologic subtype and stage mix are not stated for this series.

    Relative survival excludes deaths from other causes. 'Observed' is the table's label for the actual yearly value, as opposed to the modelled trend value in the adjacent column (91.60% for 2018). The table column is headed 'Year' and the chart is titled 'SEER 8 5-Year Relative Survival Percent from 1975-2018'; neither labels the year as year of diagnosis. SEER 8 is the grouping of eight registries available from 1975 (SEER registry-groupings page), and single-year values fluctuate (for example 69.05% in 1979 and 75.22% in 1980 in the same series). The page does not say how much of the change reflects treatment, changes in staging methods or stage mix, or age mix. After 2018 the table shows only modelled trend values (91.85% for 2019 to 92.76% for 2023). Observed values from 2010 to 2018 range from 88.01% (2010) to 94.17% (2018). Compare only with other values from the same SEER 8 series, and read them beside the death-rate values.

    Source

  • 5-year relative survival · United States, SEER 21 (excluding IL)

    • 89.3%

      2016-2022

    People with Hodgkin lymphoma; the headline five-year relative survival figure on the SEER Cancer Stat Facts Hodgkin lymphoma page (SEER 21, excluding IL), all stages. Race, sex and age range are not stated beside the figure; the page's other tables are labelled all races, both sexes.

    A different registry set and period from the SEER 8 series, so it is not a continuation of the 1975-2018 values and must not be subtracted from them. It is lower than the SEER 8 observed value for 2018 (94.17%); the page does not explain the difference, so it must not be read as a decline in survival. The page labels the period '2016-2022' and does not say whether this is year of diagnosis. Relative survival excludes deaths from other causes. The page gives no breakdown of this figure by age or histology; the stage breakdown is a separate SEER 17 table (see the stage entries).

    Source

  • 5-year relative survival · United States, SEER 17 registries

    • 92.7%

      2016-2022; stage I at diagnosis (13% of cases)

    People with Hodgkin lymphoma, all races, both sexes, by Ann Arbor stage at diagnosis (SEER 17, 2016-2022, per the page's stage table); the page's label for stage I is 'Confined to Single Region'.

    Stage-specific value from the page's 'Survival by Stage' table (stage mix on the page: 13% I, 38% II, 19% III, 25% IV, 5% unstaged; 5-year relative survival for unstaged cases 82.1%). The page states that statistics by stage include only cases coded as lymphoma or lymphoma-CLL/SLL in the EOD 2018 schema, and that stage at diagnosis has a strong influence on survival. A different registry set (SEER 17) and period from the SEER 8 series and from the SEER 21 headline figure, so do not subtract or chain them. The stage I value (92.7%) is below the stage II value (95.4%); the page does not comment on this, so the order of the values should not be read as a ranking. Five-year figure only.

    Source

  • 5-year relative survival · United States, SEER 17 registries

    • 95.4%

      2016-2022; stage II at diagnosis (38% of cases)

    People with Hodgkin lymphoma, all races, both sexes, by Ann Arbor stage at diagnosis (SEER 17, 2016-2022, per the page's stage table); the page's label for stage II is 'Involving Mulitple Regions' (spelling as printed on the page).

    Stage-specific value from the page's 'Survival by Stage' table (stage mix on the page: 13% I, 38% II, 19% III, 25% IV, 5% unstaged; 5-year relative survival for unstaged cases 82.1%). The page states that statistics by stage include only cases coded as lymphoma or lymphoma-CLL/SLL in the EOD 2018 schema, and that stage at diagnosis has a strong influence on survival. A different registry set (SEER 17) and period from the SEER 8 series and from the SEER 21 headline figure, so do not subtract or chain them. The stage I value (92.7%) is below the stage II value (95.4%); the page does not comment on this, so the order of the values should not be read as a ranking. Five-year figure only.

    Source

  • 5-year relative survival · United States, SEER 17 registries

    • 87.7%

      2016-2022; stage III at diagnosis (19% of cases)

    People with Hodgkin lymphoma, all races, both sexes, by Ann Arbor stage at diagnosis (SEER 17, 2016-2022, per the page's stage table); the page's label for stage III is 'Spread to Both Sides of Diaphragm'.

    Stage-specific value from the page's 'Survival by Stage' table (stage mix on the page: 13% I, 38% II, 19% III, 25% IV, 5% unstaged; 5-year relative survival for unstaged cases 82.1%). The page states that statistics by stage include only cases coded as lymphoma or lymphoma-CLL/SLL in the EOD 2018 schema, and that stage at diagnosis has a strong influence on survival. A different registry set (SEER 17) and period from the SEER 8 series and from the SEER 21 headline figure, so do not subtract or chain them. The stage I value (92.7%) is below the stage II value (95.4%); the page does not comment on this, so the order of the values should not be read as a ranking. Five-year figure only.

    Source

  • 5-year relative survival · United States, SEER 17 registries

    • 82.8%

      2016-2022; stage IV at diagnosis (25% of cases)

    People with Hodgkin lymphoma, all races, both sexes, by Ann Arbor stage at diagnosis (SEER 17, 2016-2022, per the page's stage table); the page's label for stage IV is 'Diffuse or Disseminated Involvement'.

    Stage-specific value from the page's 'Survival by Stage' table (stage mix on the page: 13% I, 38% II, 19% III, 25% IV, 5% unstaged; 5-year relative survival for unstaged cases 82.1%). The page states that statistics by stage include only cases coded as lymphoma or lymphoma-CLL/SLL in the EOD 2018 schema, and that stage at diagnosis has a strong influence on survival. A different registry set (SEER 17) and period from the SEER 8 series and from the SEER 21 headline figure, so do not subtract or chain them. The stage I value (92.7%) is below the stage II value (95.4%); the page does not comment on this, so the order of the values should not be read as a ranking. Five-year figure only.

    Source

  • Age-standardised mortality · United States

    • 1.31per 100,000

      1975 (observed)

    People of all races and both sexes in the United States; age-adjusted death rate from US mortality data (not SEER registries), 'Death Rate - U.S.' column of the table on the SEER Cancer Stat Facts Hodgkin lymphoma page (chart note: deaths come from U.S. Mortality; all races, both sexes; rates are age-adjusted).

    Observed value from the table; the adjacent modelled trend column (1.27) is not used. Death rates describe the whole US population and are not measured from the date of diagnosis, so they are not a survival measure and depend on how many people are diagnosed. In the same table the age-adjusted rate of new cases in the SEER 8 column (per 100,000) was 3.10 in 1975, i.e. in a similar range while the death rate fell. The page does not say how Hodgkin lymphoma deaths were coded across the years or attribute the change in the rate to a cause. Hodgkin lymphoma is not a screened cancer and the page does not discuss screening, so no screening-related pairing is made.

    Source

  • Age-standardised mortality · United States

    • 0.66per 100,000

      1990 (observed)

    People of all races and both sexes in the United States; age-adjusted death rate from US mortality data (not SEER registries), 'Death Rate - U.S.' column of the table on the SEER Cancer Stat Facts Hodgkin lymphoma page (chart note: deaths come from U.S. Mortality; all races, both sexes; rates are age-adjusted).

    Observed value from the table; the adjacent modelled trend column (0.67) is not used. Death rates describe the whole US population and are not measured from the date of diagnosis, so they are not a survival measure and depend on how many people are diagnosed. In the same table the age-adjusted rate of new cases in the SEER 8 column (per 100,000) was 2.99 in 1990, i.e. in a similar range while the death rate fell. The page does not say how Hodgkin lymphoma deaths were coded across the years or attribute the change in the rate to a cause. Hodgkin lymphoma is not a screened cancer and the page does not discuss screening, so no screening-related pairing is made.

    Source

  • Age-standardised mortality · United States

    • 0.46per 100,000

      2000 (observed)

    People of all races and both sexes in the United States; age-adjusted death rate from US mortality data (not SEER registries), 'Death Rate - U.S.' column of the table on the SEER Cancer Stat Facts Hodgkin lymphoma page (chart note: deaths come from U.S. Mortality; all races, both sexes; rates are age-adjusted).

    Observed value from the table; the adjacent modelled trend column (0.49) is not used. Death rates describe the whole US population and are not measured from the date of diagnosis, so they are not a survival measure and depend on how many people are diagnosed. In the same table the age-adjusted rate of new cases in the SEER 8 column (per 100,000) was 2.78 in 2000, i.e. in a similar range while the death rate fell. The page does not say how Hodgkin lymphoma deaths were coded across the years or attribute the change in the rate to a cause. Hodgkin lymphoma is not a screened cancer and the page does not discuss screening, so no screening-related pairing is made.

    Source

  • Age-standardised mortality · United States

    • 0.38per 100,000

      2010 (observed)

    People of all races and both sexes in the United States; age-adjusted death rate from US mortality data (not SEER registries), 'Death Rate - U.S.' column of the table on the SEER Cancer Stat Facts Hodgkin lymphoma page (chart note: deaths come from U.S. Mortality; all races, both sexes; rates are age-adjusted).

    Observed value from the table; the adjacent modelled trend column (0.36) is not used. Death rates describe the whole US population and are not measured from the date of diagnosis, so they are not a survival measure and depend on how many people are diagnosed. In the same table the age-adjusted rate of new cases in the SEER 8 column (per 100,000) was 2.85 in 2010, i.e. in a similar range while the death rate fell. The page does not say how Hodgkin lymphoma deaths were coded across the years or attribute the change in the rate to a cause. Hodgkin lymphoma is not a screened cancer and the page does not discuss screening, so no screening-related pairing is made.

    Source

  • Age-standardised mortality · United States

    • 0.21per 100,000

      2024 (observed; last year in the table)

    People of all races and both sexes in the United States; age-adjusted death rate from US mortality data (not SEER registries), 'Death Rate - U.S.' column of the table on the SEER Cancer Stat Facts Hodgkin lymphoma page (chart note: deaths come from U.S. Mortality; all races, both sexes; rates are age-adjusted).

    Observed value from the table; the adjacent modelled trend column (0.23) is not used. Death rates describe the whole US population and are not measured from the date of diagnosis, so they are not a survival measure and depend on how many people are diagnosed. In the same table the age-adjusted rate of new cases in the SEER 8 column (per 100,000) was 2.52 in 2023 (the 2024 incidence cell is blank), i.e. in a similar range while the death rate fell. The page does not say how Hodgkin lymphoma deaths were coded across the years or attribute the change in the rate to a cause. Hodgkin lymphoma is not a screened cancer and the page does not discuss screening, so no screening-related pairing is made. The page headline gives 0.2 per 100,000 for 2020-2024 deaths and an average fall of 3.1% per year over 2015-2024; use one or the other, not both.

    Source

  • 10-year relative survival · United Kingdom (as worded on the Cancer Research UK page)

    • 48.6%

      Diagnosed in the 1970s

    People diagnosed with Hodgkin lymphoma; the Cancer Research UK health-professional survival page words it as 'almost 1 in 2 (48.6%)' who 'survived their disease beyond ten years'. Age range and sex are not stated for this figure.

    A different country, data source and method from the SEER series: do not compare or subtract. The page does not label the measure net, relative or observed (it says 'survive their disease'), nor give the geographic coverage of the 1970s figure beyond 'UK' in the surrounding text, so it is entered under the nearest available metric. The page states that survival trends reflect a combination of changes in treatment and stage distribution, which vary by age, sex and deprivation.

    Source

  • 10-year relative survival · United Kingdom (Cancer Research UK)

    • 81.6%

      Predicted for people diagnosed in 2018

    People diagnosed with Hodgkin lymphoma in the UK; the page words it as 'predicted that more than 8 in 10 (81.6%)' survive their disease for ten years or more (2018). No overall age range is stated.

    A modelled (predicted) value, not an observed ten-year follow-up, for a different country and method from the SEER series; do not compare or subtract. The measure (net, relative or observed) is not named on the page. The page's age breakdown for 2018 is wide: more than 9 in 10 for ages 15-44 (95.6% women, 93.9% men) against around 1 in 3 for women (32%) and almost 1 in 5 for men (18.4%) aged 75-99, so the overall figure mixes very different groups. The page states that survival trends reflect a combination of changes in treatment and stage distribution, which vary by age, sex and deprivation.

    Source

Survival figures are affected by earlier detection (lead time) and overdiagnosis, and by changes in who is diagnosed. For screened cancers, read them alongside mortality.

Evidence chains

A lane follows one defined population and setting, where each new trial tests against what was then standard. Compare only within a lane, and read every comparison as illustrative.

Early-stage Hodgkin lymphoma, first line

Newly diagnosed stage I or II Hodgkin lymphoma. Risk-group definitions differ by study: GHSG favourable (HD10) and unfavourable (HD17) groups, EORTC/LYSA (H10) and stage IA/IIA (RAPID). · Localised · endpoint: PFS

Results are not comparable across trials.

The 1950 and 1962 milestones are radiotherapy-era series without a comparison arm on this endpoint and are not plotted. HD10 reported freedom from treatment failure (FFTF), not progression-free survival, and compares four with two cycles of ABVD pooled over radiation dose (drawn as a distinct marker). H10 appears twice, once per risk group, and shows only the PET-negative de-escalation comparison (ABVD alone versus ABVD with involved-node radiotherapy); its PET-positive escalation comparison is a different question and is not drawn. RAPID measures PFS at 3 years, while H10, HD16 and HD17 measure it at 5 years. Risk groups, PET thresholds, radiation fields and chemotherapy backbones differ, and in HD16 and HD17 the PET-guided arms omit radiotherapy in different populations. Compare only each trial's own two arms.

Each pair shows one trial: its control arm and its experimental arm. Yesterday's experimental arm is often today's control. Populations, definitions and follow-up differ.

020406080100PFS at 60 months (%)20102014201420192019HD10H10H10HD16HD17
  • experimental arm
  • control arm
  • different endpoint from the lane's
  • step line through experimental values
PFS at 60 months, rate, across 5 trials in this lane. HD10 (2010): experimental 91.1 % vs control 93 %; H10 (2014): experimental 87.1 % vs control 99 %; H10 (2014): experimental 89.6 % vs control 92.1 %; HD16 (2019): experimental 86.1 % vs control 93.4 %; HD17 (2019): experimental 95.1 % vs control 97.3 %.
Data table
TrialYearEndpointControl (%)Experimental (%)
HD102010FFTF (differs from lane)93 %91.1 %
H102014PFS99 %87.1 %
H102014PFS92.1 %89.6 %
HD162019PFS93.4 %86.1 %
HD172019PFS97.3 %95.1 %
RAPID2015PFS (not plotted: different measure or time point)94.6 %90.8 %

Advanced-stage Hodgkin lymphoma, chemotherapy era

Previously untreated advanced-stage Hodgkin's disease (stage III-IV; the German trial also included unfavourable stage IIB). Staging and response criteria are those of each period. · Locally advanced · endpoint: FFTF

Results are not comparable across trials.

The MOPP series (1970) is uncontrolled, and the 1975 ABVD versus MOPP report gives only complete-remission rates; neither is drawn. The CALGB trial reported failure-free survival (FFS), not freedom from treatment failure (FFTF), so it is drawn as a distinct marker, and its comparison is ABVD against MOPP (the MOPP/ABVD arm is not drawn). The German HD9 trial's control was COPP-ABVD, not MOPP or ABVD, and its experimental arm is increased-dose BEACOPP. Eras, age limits, staging methods, endpoint definitions and salvage options differ, and both trials report 5-year rates. The lane shows lineage, not a ranking of regimens; compare only each trial's own arms.

Each pair shows one trial: its control arm and its experimental arm. Yesterday's experimental arm is often today's control. Populations, definitions and follow-up differ.

020406080100FFTF at 60 months (%)19922003CALGB 8251HD9
  • experimental arm
  • control arm
  • different endpoint from the lane's
  • step line through experimental values
FFTF at 60 months, rate, across 2 trials in this lane. CALGB 8251 (1992): experimental 61 % vs control 50 %; HD9 (2003): experimental 87 % vs control 69 %.
Data table
TrialYearEndpointControl (%)Experimental (%)
CALGB 82511992FFS (differs from lane)50 %61 %
HD92003FFTF69 %87 %

Advanced-stage Hodgkin lymphoma, PET-adapted and novel agents

Previously untreated advanced-stage classic Hodgkin lymphoma. Eligible ages and stage definitions differ: RATHL adults 18 and older, HD18 and HD21 aged 18 to 60, ECHELON-1 stage III or IV, S1826 stage III or IV aged 12 and older. · Locally advanced · endpoint: PFS

Results are not comparable across trials.

Two lineages with different controls: ABVD, then brentuximab vedotin with AVD (ECHELON-1's experimental arm, which is S1826's control), and escalated BEACOPP (the control in HD18 and HD21). ECHELON-1's primary endpoint is modified PFS (progression, death or non-complete response with subsequent therapy), a different endpoint from the PFS of the other trials, so it is drawn as a distinct marker. RATHL and HD18 are PET-guided de-escalation comparisons within the PET-negative group (omitting bleomycin; four rather than standard cycles of escalated BEACOPP); RATHL and S1826 are not restricted by PET. Landmark times differ (RATHL 3 years, HD18 5 years, ECHELON-1 and S1826 2 years, HD21 4 years), and only values at the same landmark share an axis. HD21's primary endpoints were treatment-related morbidity and PFS. No trial compares BrECADD with nivolumab-AVD. Compare only each trial's own two arms.

Each pair shows one trial: its control arm and its experimental arm. Yesterday's experimental arm is often today's control. Populations, definitions and follow-up differ.

020406080100PFS at 36 months (%)2016RATHL
  • experimental arm
  • control arm
  • different endpoint from the lane's
  • step line through experimental values
PFS at 36 months, rate, across 1 trial in this lane. RATHL (2016): experimental 84.4 % vs control 85.7 %.
Data table
TrialYearEndpointControl (%)Experimental (%)
RATHL2016PFS85.7 %84.4 %
HD182017PFS (not plotted: different measure or time point)90.8 %92.2 %
ECHELON-12017mPFS (differs from lane) (not plotted: different measure or time point)77.2 %82.1 %
S18262024PFS (not plotted: different measure or time point)83 %92 %
HD212024PFS (not plotted: different measure or time point)90.9 %94.3 %

Relapsed or refractory Hodgkin lymphoma

Relapsed or refractory Hodgkin lymphoma. Transplant eligibility, earlier treatment and the point in the pathway differ: high-dose therapy for relapse (1993 milestone), and brentuximab vedotin consolidation after autologous transplant in unfavourable-risk disease (AETHERA). · Relapsed / refractory · endpoint: PFS

Results are not comparable across trials.

The 1993 milestone's German trial reported freedom from treatment failure (FFTF) at 3 years, not PFS, so it is drawn as a distinct marker; the British trial in the same milestone has no plottable result. AETHERA reports median PFS, a different measure, so the two do not share an axis and are listed side by side rather than ranked. The brentuximab vedotin and PD-1 milestones are single-arm studies with response-based endpoints and are not drawn on a PFS axis. Consolidation after transplant (AETHERA) and treatment of relapse before or after transplant are not interchangeable settings. Compare only each trial's own two arms.

Each pair shows one trial: its control arm and its experimental arm. Yesterday's experimental arm is often today's control. Populations, definitions and follow-up differ.

020406080100PFS at 36 months (%)1993ghsg-ebmt-beam-hsct-relapsed
  • experimental arm
  • control arm
  • different endpoint from the lane's
  • step line through experimental values
PFS at 36 months, rate, across 1 trial in this lane. ghsg-ebmt-beam-hsct-relapsed (1993): experimental 55 % vs control 34 %.
Data table
TrialYearEndpointControl (%)Experimental (%)
ghsg-ebmt-beam-hsct-relapsed1993FFTF (differs from lane)34 %55 %
AETHERA2015PFS (not plotted: different measure or time point)24.1 months42.9 months

Standard of care, then and now

How the usual sequence of treatment changed for one setting. Choose a point in time; each step links to the milestone behind it.

Advanced-stage Hodgkin lymphoma: first-line chemotherapy

Previously untreated advanced-stage Hodgkin lymphoma · Locally advanced

  1. Chemotherapy1ABVD, bleomycin dropped if PET-negativeRATHL: dropping bleomycin after a negative interim PET (2016)
  2. Chemotherapy2PET-guided escalated BEACOPP (HD18)HD18: PET-2-guided cycles of escalated BEACOPP (2017)
  3. Antibody–drug conjugate3Brentuximab vedotin + AVD vs ABVDECHELON-1: brentuximab vedotin plus AVD vs ABVD (2017)
  4. Antibody–drug conjugate4BrECADD vs escalated BEACOPP (HD21)HD21: BrECADD versus escalated BEACOPP (2024)
  5. Immunotherapy5Nivolumab + AVD vs BV + AVD (S1826)S1826: nivolumab plus AVD versus BV plus AVD (2024)
Today. Based only on the studies cited in each step; the regulatory actions are listed in the milestones. Earlier regimens above are not withdrawn by this diagram.
Text version
  • 1975: MOPP combination chemotherapy → ABVD tested against MOPP (preliminary)
  • 2003: ABVD, MOPP/ABVD compared with MOPP → BEACOPP compared with COPP-ABVD (HD9)
  • 2018: ABVD, bleomycin dropped if PET-negative → PET-guided escalated BEACOPP (HD18) → Brentuximab vedotin + AVD vs ABVD
  • Today: ABVD, bleomycin dropped if PET-negative → PET-guided escalated BEACOPP (HD18) → Brentuximab vedotin + AVD vs ABVD → BrECADD vs escalated BEACOPP (HD21) → Nivolumab + AVD vs BV + AVD (S1826)

Today and tomorrow

Standard of care today

Localised

Early-stage classical Hodgkin lymphoma (stage I-II). Guideline text read:

  • the 2026 EHA Clinical Practice Guideline (open-access text). For early-stage favourable disease it recommends two cycles of ABVD followed by 20 Gy involved-site radiotherapy, and says omission of radiotherapy can be discussed after a complete metabolic remission where the late risks of radiotherapy are judged to outweigh its benefit, citing the RAPID, H10 and HD16 trials, which showed worse disease control with chemotherapy alone in PET-negative patients. For early-stage unfavourable disease in people aged 60 or younger it recommends two cycles of escalated BEACOPP plus two of ABVD, with 30 Gy involved-site radiotherapy only if the PET/CT at the end of chemotherapy is positive
  • a procarbazine-free escalated BEACOPP variant is described as an alternative (lower-grade evidence), and four cycles of ABVD followed by 30 Gy involved-site radiotherapy as the option if a less intensive approach is preferred. In people over 60 bleomycin is limited to no more than two cycles, with omission considered over 70. This entry restates the EHA text and is not a ranking of options by this site. NCCN Hodgkin Lymphoma, Version 1.2026 and the ESMO 2018 guideline are cited by identifier only
  • their text was not read. No FDA or EMA action specific to early-stage disease was read for this page
Eichenauer DA, André M, Borchmann P, Collins GP, Doherty I, Eich HT, et al 2026Advani RH, Kelsey CR, Armand P, Bello CM, Benitez CM, Bond D, et al 2026Eichenauer DA, Aleman BMP, André M, Federico M, Hutchings M, Illidge T, et al 2018
Any setting

Previously untreated advanced-stage (stage III-IV) classical Hodgkin lymphoma. FDA actions read:

  • 20 March 2018, brentuximab vedotin with doxorubicin, vinblastine and dacarbazine (AVD) for adults with previously untreated stage III or IV disease (supplement S-097
  • the letter states that approval fulfils the commitments made under 21 CFR 601.41 and the postmarketing requirement for a randomized phase 3 study of this combination against ABVD)
  • 20 March 2026, nivolumab with AVD for adults and pediatric patients 12 years and older with previously untreated stage III or IV disease (supplement S-135). The S-135 letter and the FDA announcement do not say whether the first-line nivolumab approval is traditional or accelerated
  • they state only that the two relapsed or refractory indications were converted to traditional approval. The FDA announcement gives the basis as SWOG S1826 (994 patients, nivolumab plus AVD versus brentuximab vedotin plus AVD, progression-free survival hazard ratio 0.42, 95% CI 0.27 to 0.67, per investigator, median follow-up 13.7 months)
  • this is a comparison against brentuximab vedotin plus AVD, not against ABVD. The Adcetris US prescribing information read (openFDA record, effective 11 November 2025) lists no BrECADD indication
  • the US regulatory status of BrECADD was not established. EMA: the CHMP opinion of 25 April 2025 (procedure II-111) added Adcetris with etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone (BrECADD) for adults with previously untreated CD30-positive stage IIB with risk factors, stage III or stage IV disease
  • the Union Register shows a Commission decision dated 2 June 2025 for procedure EMEA/H/C/002455/II/0111. The same CHMP document lists Adcetris with AVD for previously untreated CD30-positive stage III or IV disease among the existing indications
  • the date of that extension was not established. The CHMP opinion of 23 April 2026 added Opdivo with AVD for adults and adolescents 12 years and older with previously untreated stage III or IV disease
  • the Union Register shows a Commission decision dated 28 May 2026 for procedure EMA/VR/0000304938, matched to the CHMP opinion by that procedure number. Guideline text read (EHA 2026, restated and not ranked by this site): BrECADD for four or six cycles by interim PET/CT, followed by PET/CT-guided radiotherapy, for people aged 60 or younger
  • six cycles of nivolumab plus AVD as an alternative for younger people (the text notes that longer follow-up may be needed) and as the recommended approach for older people who can have multiagent chemotherapy
  • for younger people without access to BrECADD or nivolumab plus AVD, escalated BEACOPP-based treatment, brentuximab vedotin plus AVD or ABVD-based sequences are described as options. NCCN Version 1.2026 is cited by identifier only
  • its text was not read
U 2018U 2026U 2026U 2025European Medicines Agency, CHMP 2025European Commission 2026European Medicines Agency, CHMP 2026European Commission 2026Eichenauer DA, André M, Borchmann P, Collins GP, Doherty I, Eich HT, et al 2026Advani RH, Kelsey CR, Armand P, Bello CM, Benitez CM, Bond D, et al 2026
Relapsed / refractory

Relapsed or refractory classical Hodgkin lymphoma. FDA actions read:

  • brentuximab vedotin, accelerated approval on 19 August 2011 after failure of autologous stem cell transplant (ASCT), or after failure of at least two prior multi-agent regimens in people who are not ASCT candidates
  • 17 August 2015, a consolidation indication for people at high risk of relapse or progression after ASCT, with the letter stating that the approval fulfils the accelerated approval requirement for the 2011 Hodgkin indication. Nivolumab: accelerated approval on 17 May 2016 after ASCT and post-transplant brentuximab vedotin
  • the FDA announcement of March 2026 says the three-or-more-lines indication also received accelerated approval in 2017, and the March 2026 letter dates the corresponding supplement (S-031) approval letter 25 April 2017 (that 2017 letter itself was not read)
  • on 20 March 2026 both relapsed or refractory indications were converted to traditional approval. Pembrolizumab: accelerated approval on 14 March 2017 for adult and pediatric patients with refractory disease or relapse after three or more prior lines
  • traditional approval on 14 October 2020 for adults with relapsed or refractory disease and for pediatric patients with refractory disease or relapse after two or more lines. EMA: the CHMP document of 23 April 2026 lists Opdivo monotherapy after ASCT and brentuximab vedotin, and Opdivo with brentuximab vedotin for children 5 years and older, adolescents and adults up to 30 years with disease after one prior line, among the full indications (dates of those extensions not established). Guideline text read (EHA 2026, restated and not ranked): high-dose chemotherapy with ASCT is the standard for most eligible people
  • where PD-1 inhibitors are available, salvage before transplant is a PD-1 inhibitor with chemotherapy given together or in sequence
  • brentuximab vedotin with chemotherapy is recommended for brentuximab-naive people when PD-1 inhibitors are unavailable or unsuitable
  • brentuximab vedotin maintenance after ASCT is recommended for high-risk people
  • allogeneic transplant should be discussed with eligible people who respond to, or progress on, PD-1 inhibitors after ASCT
  • single-agent PD-1 inhibitors are preferred for those not eligible for ASCT. NCCN Version 1.2026 is cited by identifier only
U 2011U 2015U 2016U 2026U 2026U 2017U 2020European Medicines Agency, CHMP 2026Eichenauer DA, André M, Borchmann P, Collins GP, Doherty I, Eich HT, et al 2026Advani RH, Kelsey CR, Armand P, Bello CM, Benitez CM, Bond D, et al 2026
Any setting

Children and adolescents. FDA, 10 November 2022:

  • brentuximab vedotin with doxorubicin, vincristine, etoposide, prednisone and cyclophosphamide for pediatric patients 2 years and older with previously untreated high-risk classical Hodgkin lymphoma (supplement S-106). The nivolumab-with-AVD indication (FDA 20 March 2026
  • CHMP opinion 23 April 2026) starts at age 12 in the US and in the EU. The NCCN Pediatric Hodgkin Lymphoma guideline (Version 3.2021, J Natl Compr Canc Netw 2021;19(6):733-754) is cited by identifier only and its text was not read
  • a later version may exist. The EHA 2026 text read for this page is a guideline for adults and does not replace pediatric protocols
U 2022U 2026European Medicines Agency, CHMP 2026Flerlage JE, Hiniker SM, Armenian S, Benya EC, Bobbey AJ, Chang V, et al 2021
Any setting

Survivorship and long-term follow-up (guideline text read:

  • EHA 2026, restated and not ranked). The text says reproductive counselling should be offered before treatment to everyone who may want children. After treatment, PET/CT, CT or MRI confirms remission
  • thereafter people are followed clinically, and surveillance imaging is not indicated unless symptoms occur. It advises asking about long-term toxicity, especially second malignancies, heart and lung disease, fatigue, neuropathy, bone health, sexual function and fertility
  • yearly thyroid function testing if the neck was irradiated
  • and annual blood pressure and lipid testing where possible. For women whose breasts received radiotherapy before age 36 it advises annual mammography and/or breast MRI starting 8 years after radiotherapy and not before age 25, and says cumulative doxorubicin dose should also be considered. It recommends structured survivorship care plans. No FDA or EMA action is relevant to this entry
Eichenauer DA, André M, Borchmann P, Collins GP, Doherty I, Eich HT, et al 2026

Trials to watch

  • AHOD2131 NCT05675410

    In newly diagnosed stage I-II classical Hodgkin lymphoma in children and adults (registry ages 5 to 60), treated with interim-response-adapted therapy, does an immuno-oncology regimen of brentuximab vedotin and nivolumab differ from standard therapy (ABVD-based chemotherapy, with or without radiotherapy, as the arm labels describe) in progression-free survival, analysed separately in rapid and slow early responders? Registry status: recruiting.

  • RADAR NCT04685616

    In previously untreated stage IA/IIA Hodgkin lymphoma (registry ages 16 to 69), with PET-response-adapted treatment, does A2VD (registered as doxorubicin, brentuximab vedotin, vinblastine and dacarbazine) with or without involved-site radiotherapy differ from ABVD with or without involved-site radiotherapy in progression-free survival, measured to 3 years from the end of treatment? Registry status: recruiting.

  • FIL PRIORITY NCT07256158

    In adults with newly diagnosed early-stage unfavourable Hodgkin lymphoma who reach a complete metabolic response (Deauville score 1 to 3) after two cycles of ABVD, is involved-site radiotherapy at 20 Gy non-inferior to 30 Gy for progression-free survival? Registry status: recruiting.

  • IMM01 plus tislelizumab NCT06465446

    In adults with classical Hodgkin lymphoma refractory to PD-(L)1 blockade, does IMM01 (timdarpacept) plus tislelizumab differ from physician's-choice chemotherapy (bendamustine or gemcitabine, per the arm description) in progression-free survival per Lugano 2014 as assessed by an independent review committee? Registry status: not yet recruiting; the record was last updated in June 2024 and its planned start and completion dates have passed, so the status may be out of date.

  • EuroNet-PHL-C2 NCT02684708

    In children and adolescents (registry upper age 25) with classical Hodgkin lymphoma, after induction therapy does the intensified DECOPDAC-21 consolidation differ from the standard COPDAC-28 consolidation in 5-year event-free survival, as the registry arm descriptions state for intermediate and advanced stages? Registry status: completed; no peer-reviewed report of this comparison was found in a PubMed search on 20 October 2026.

Pioneers

  • Thomas Hodgkin

    1798-1866 · Physician and morbid anatomist at Guy's Hospital, London; author of the 1832 paper on enlargement of the absorbent glands and spleen

  • Samuel Wilks

    Physician at Guy's Hospital, London; author of the 1856 and 1865 papers that led to the name Hodgkin's disease

  • Carl Sternberg

    Pathologist at the Institute for Pathological Histology and Bacteriology, University of Vienna, as named on the title page of his 1898 paper on a form of tuberculosis of the lymphatic apparatus in cases labelled pseudoleukaemia

  • Dorothy Reed

    born 1874 · Fellow in pathology at Johns Hopkins University; author of the 1902 Johns Hopkins Hospital Reports paper on the pathological changes in Hodgkin's disease

  • Vera Peters

    1911-1993 · Radiotherapist; author of the 1950 Toronto study of survival in Hodgkin disease

  • René Gilbert

    Author of a 1939 report from Geneva, Switzerland, on radiotherapy in Hodgkin disease

  • Henry Kaplan

    Hodgkin disease researcher at Stanford University Medical School; author of the 1962 Radiology paper on radical radiotherapy and senior author of the 1985 summary of the Stanford randomised trials

References

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Every figure was checked against its primary source to the extent possible. Items that could not be fully confirmed are marked “needs review”. Educational history, not medical advice.

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1950TreatmentRadiation

landmarkLocalisedNeeds review

Peters links stage to survival after radiotherapy (1950)

In 1950 Vera Peters in Toronto reported survival for 113 histologically proven cases of Hodgkin disease treated with radiotherapy, grouped by how far the disease had spread. Those with the least spread did best. A historian writes that her figures suggested cure might be possible; she did not claim it, and she later recalled that acceptance took about ten years.

Peters (Toronto, 1950), as described by Cowan 2008: 113 histologically proven cases treated with radiotherapy and grouped into three stages by extent of disease. Stage I: 5-year survival 88%, 10-year 79%, median survival over 11.6 years (stage II over 7.8 years, stage III 1.9 years). Per Cowan, Peters did not claim cure in this paper. Figures are from Cowan's account; the 1950 paper was not opened.

Radiotherapy for Hodgkin disease was in use well before 1950, but cure was not expected. René Gilbert of Geneva reported a 17-year experience in 1939: lymph nodes shrank and symptoms eased, and he calculated that survival was roughly doubled, but he stressed that relapses occurred [1].

In Toronto, Gordon Richards had installed a 400-kV machine in 1937 and Vera Peters worked with him [1]. In an account Cowan draws from an oral-history interview, Richards asked her in 1947 to review the department's Hodgkin experience [1]. Her 1950 paper reported 113 histologically proven cases [1]. By grouping patients according to survival, she produced what Cowan calls the first clinical staging system for the disease, with three stages [1]. For stage I, 5-year survival was 88% and 10-year survival 79% [1].

Cowan writes that these data were sufficient to suggest the possibility of cure in stage I, but that Peters did not make that claim in the first paper [1]. The response was lukewarm; Peters later said it took about ten years before colleagues began to believe it [1]. In 1963 Easson and Russell published a paper making the case for curability, which Cowan describes as finally winning acceptance among practitioners [1]. A different dating appears in Hoppe's 2005 lecture, which places the demonstration of curative potential of high-dose extended-field irradiation in the mid-1960s, crediting Peters and Kaplan [2].

Standard before

Radiotherapy was in use. Gilbert's 1939 report, as described by Cowan, estimated about doubled survival with relapses, and in the account of Richards's 1947 request to Peters, the textbooks of the time were said to call Hodgkin disease fatal.

What changed

Per Cowan 2008, Peters's three-stage classification became the basis of the later four-stage system, and Easson and Russell in 1963 argued for curability. Cowan reports that Harrison's textbook did not mention curability until the 1970s.

Why it mattered

According to Cowan, the paper tied survival to extent of disease, offered a way to compare series and plan treatment, and gave survival figures that suggested stage I disease might be curable by intensive radiotherapy including adjacent nodes. Peters later recalled that it took about ten years for colleagues to believe it.

Caveats

  • Numbers and narrative come from a 2008 historical review (Cowan); the 1950 and 1939 originals carry no PMID or DOI and were not opened.
  • The 1950 series is a single-centre review of 113 treated cases, with no comparison group, so it cannot isolate the effect of radiotherapy.
  • Peters did not claim cure in 1950; that stage I figures suggested the possibility of cure is Cowan's reading of her survival curves.
  • Gilbert's report is from 1939; the entry is dated by Peters's 1950 paper. Hoppe 2005 dates the demonstration of curative potential to the mid-1960s, crediting Peters and Kaplan, whereas Cowan emphasises Peters's 1950 paper and the 1963 Easson and Russell paper; the accounts differ on timing and attribution.
  • The account of Richards's request in 1947 rests on a 1979 oral-history interview cited by Cowan and is a secondary source.
  • The role of Easson and Russell (1963) rests on Cowan's description; that paper has no PubMed abstract and was not read.