A 35-year-old man presents with fever, night sweats, pruritus, and cervical lymphadenopathy. Biopsy shows Reed-Sternberg cells with a background of eosinophils and plasma cells. CD15+ and CD30+ by IHC. PET-CT shows stage IIA disease (above the diaphragm, no B symptoms, ESR 38). What is the current preferred treatment?
- A 2 cycles of ABVD followed by involved-site radiotherapy (ISRT) ✓
- B 6 cycles of BEACOPP-escalated
- C 6 cycles of ABVD alone
- D Brentuximab vedotin plus radiotherapy
Correct answer: A. 2 cycles of ABVD followed by involved-site radiotherapy (ISRT)
Explanation
This is classical Hodgkin lymphoma, nodular sclerosis type, stage IIA (early favourable disease — no B symptoms, ESR <50). GHSG guidelines recommend 2 cycles of ABVD followed by 20 Gy involved-site radiotherapy (ISRT), which achieves >90% long-term disease-free survival with reduced treatment toxicity. BEACOPP-escalated is reserved for advanced stage (III/IV) or unfavourable early disease. PET-adapted strategies (based on interim PET after 2 cycles) allow radiotherapy omission in PET-negative patients in some protocols (RAPID trial).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.