A 60-year-old man presents with constitutional symptoms and a left supraclavicular node biopsy showing large cells with bi-lobed nuclei, prominent eosinophilic 'owl eye' nucleoli, and a CD30+/CD15+ immunophenotype with CD45 negativity. PET-CT shows disease above and below the diaphragm without extranodal involvement, 4 nodal sites. Ann Arbor stage III. Bulk disease is absent. The standard chemotherapy regimen is:
- A R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
- B ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
- C BEACOPP escalated
- D BV-AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) ✓
Explanation
BV-AVD (brentuximab vedotin + AVD — bleomycin omitted) is now the preferred first-line regimen for advanced-stage classical Hodgkin lymphoma (Stage III–IV) based on the ECHELON-1 trial, which showed significantly improved 6-year progression-free survival (82.3% vs 75.3%) compared to ABVD. Brentuximab vedotin targets CD30 (uniformly expressed in cHL). ABVD remains acceptable but BV-AVD omits bleomycin (reducing pulmonary toxicity risk). R-CHOP is used for B-cell NHL (CD20-positive lymphomas). BEACOPP escalated has higher response in very high-risk but greater toxicity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.