How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

This is a tough case, and the management would depend on the extent of disease. Assuming that this is advanced stage HL, given the use of BV+AVD, I would be in favor of completing 6 cycles of therapy with a non-anthracycline-based regimen. You can consider consolidative radiation, but this would need to take into consideration the location of the tumor, given that there is a risk of cardiac toxicity with mediastinal radiation (see reference below).

I would highlight the recent randomized STOP-CA trial which investigated the use of moderate dose Atorvastatin 40 mg daily x 12 months to prevent LVEF decline (>10% from baseline to final EF of <55%) in patients with lymphomas. The study found that in the 300 patients enrolled in this trial, 9% o...

This is challenging and certainly uncommon. Given the young age, would doubt other causes of acute LV dysfunction but engaging cardio-oncology and ensuring a thoughtful workup for other causes, and intervention to promote cardiac remodeling, is critical.

But as to what to do with the lymphoma, I presume, based on BV+AVD as the treatment that this is advanced stage and not early stage disease. If it were early stage, one would be inclined to stop systemic therapy altogether, and weigh the pros and cons of consolidative radiation (making sure that any RT plan spares the myocardium). For advanced stage disease, I’d favor working to minimize the risk of recurrence by administering two additional cycles of non-anthracycline-based chemotherapy, a...