A 30-year-old woman presents with fever, painless cervical lymphadenopathy, night sweats, and weight loss >10% over 3 months. Biopsy shows Reed-Sternberg cells with CD15+, CD30+, CD45−, EBV LMP-1+. She is staged as IIA (no B symptoms at staging but had constitutional symptoms before). PET/CT shows FDG-avid mediastinal and bilateral cervical nodes only. The MOST appropriate first-line treatment is:

• A ABVD × 6 cycles
• B BV-AVD × 6 cycles
• C BEACOPP escalated × 4 cycles
• D ABVD × 2 cycles followed by involved-site radiotherapy (ISRT) if PET-negative ✓

Explanation

This is classic Hodgkin lymphoma (mixed cellularity subtype given EBV+), stage IIA (favourable per GHSG: no bulk, ≤2 nodal areas, ESR <50 with B symptoms). Current GHSG/ESMO guidelines for early favourable HL favour a response-adapted PET-guided approach: ABVD × 2 cycles then interim PET; if Deauville 1-3 (PET-negative), consolidate with ISRT (20 Gy) — this is the HD16 trial strategy. ABVD × 6 cycles alone (without radiotherapy) is used in early unfavourable or advanced disease. BV-AVD (ECHELON-1 regimen) is for advanced-stage HL. BEACOPP escalated is reserved for advanced/unfavourable disease.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.