A 28-year-old man with Hodgkin lymphoma (nodular sclerosis, Stage IIA) achieves complete metabolic response (Deauville score 1–2) after 2 cycles of ABVD on interim PET-CT. According to response-adapted strategy (RATHL trial), what should be the next step?
- A Continue ABVD for 2 more cycles then consolidation radiotherapy
- B Drop bleomycin and continue AVD for remaining cycles without consolidation radiotherapy ✓
- C Escalate to BEACOPP
- D Proceed to autologous stem cell transplantation
Correct answer: B. Drop bleomycin and continue AVD for remaining cycles without consolidation radiotherapy
Explanation
The RATHL trial (Response-Adapted Therapy in Advanced Hodgkin Lymphoma) established that patients with advanced-stage Hodgkin lymphoma achieving Deauville score 1–2 on interim PET-CT after 2 cycles of ABVD can safely de-escalate by dropping bleomycin (switching to AVD) for remaining cycles without compromising outcomes. This reduces bleomycin-related pulmonary toxicity. In early-stage favorable HL, response-adapted strategies also inform radiotherapy decisions. BEACOPP escalation is for patients with a positive interim PET (Deauville 4–5).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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