Here’s how readers responded to a You Make the Call question about treatment options for a young woman with stage 2a Hodgkin lymphoma and fertility concerns.
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Is the diagnosis non-classical lymphocyte predominant Hodgkin lymphoma? The description doesn’t mention the size of nodes, but why not give rituximab as an option?
Lauren C. Pinter-Brown, MD
University of California, Irvine
Orange County, CA
I would go with R-ABVD (rituximab, doxorubicin, bleomycin, vinblastine, dacarbazine) as done by MD Anderson Cancer Center in the past.
Thomas C. Shea, MD
University of North Carolina, Chapel Hill
Chapel Hill, NC
I think R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is the right approach. Add a luteinizing hormone-releasing hormone (LHRH) agonist after her treatment ends.
Anastasia Skandali, MD
- What are the risk factors? Hasenclever Index?
- Is there splenic involvement?
- CT and PET/CT staging done, SUV>10? Occult diffuse large B-cell lymphoma? Biopsy?
- Is the lymphoma CD20 positive?
- Limited stage: radiation; advanced stage classical Hodgkin lymphoma: chemotherapy with or without anti-CD20 antibody
Heinz-Gert Hoeffkes, MD
R-CHOP plus LHRH agonist.
Sahra Ali, FRCPath
Castle Hill Hospital
Cottingham, United Kingdom
I would use a non-fertility altering regimen such as R-ABVD (rituximab, doxorubicin, bleomycin, vinblastine, dacarbazine) or R-AVD.
I appreciate that R-CHOP is standard of care, but the chance of salvaging this patient and avoiding fertility issues with second-line treatment is high.
Antoine Sayegh, MD
Ovarian function could be spared in a young woman who requires pelvic irradiation by doing an oophoropexy. Depending upon whether the disease is unilateral or bilateral, either one or both ovaries could be transposed. This was commonly done for young women with Hodgkin lymphoma when radiation therapy was the main treatment. Ovarian function was preserved. This woman could be treated definitively with radiation.
Richard T. Hoppe
Joseph Lynch, MD
I would do ovarian tissue cryopreservation.
Glenn J. Shamdas, MD
Veterans Affairs Medical Center
I would use rituximab, cyclophosphamide, vincristine, prednisone, instead of R-CHOP.
Maria Silva, MD, PhD
I would consider watching if no rapid growth, and then treat.
Philip D. Leming MD