What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?

The question of which regimen is preferred needs to be individualized for a given AYA patient. The recent development of pediatric specific NCCN guidelines with some overlap with adult guidelines for Hodgkin Lymphoma can provide a guide. The acute toxicity tradeoffs of myelosuppression with ABVE-PC and radiation (acute and long-term risks) versus the more easily deliverable ABVD regimen need to be discussed in the context of AYA patients who may have competing life needs (need to work, lack of a caregiver, access to clinic). The choice of ABVD has the tradeoff of higher cumulative anthracycline dose and the higher risk of need for salvage therapy in about 25% of patients. With the 5-year progression free survival of ECHELON 1 now reported a...