Figure 4.

Treatment Schema: Advanced Stage Hodgkin Lymphoma.

^aPatients with concern for progression should have a biopsy. If biopsy is positive, consider transitioning to a salvage regimen.

^bInterim PET-CT after 2 cycles of escBEACOPP to ensure response. If no response, consider transitioning to salvage regimen.

^cRadiation techniques with smaller fields including involved site irradiation (ISRT) or involved nodal irradiation (INRT) are preferred.

^dRadiation to initially bulky site or with Deauville score of 4 to 5 after completion of chemotherapy.

^eConsider omitting bleomycin for elderly patients, or those with pulmonary comorbidities, or patients at risk for bleomycin lung toxicity.

ABVD indicates doxorubicin, bleomycin, vinblastine, dacarbazine; escBEACOPP, escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone; IPS, International Prognostic Score; PET-CT, positron emission tomography-computed tomography; RT, radiation therapy; Rx, treatment.

**Consideration for escalated BEACOPP in patients <age 60 years with high-risk disease. Also may treat with ABVD.