Managing Hodgkin Lymphoma recently talked with Dr. Andrew Evens of the Tufts University School of Medicine about factors that are more important when developing treatment plans for the newly diagnosed Hodgkin lymphoma patient versus those that are less important. [Editor’s note: Dr. Evens’ transcript has been edited to improve readability]

It’s a good question, and there are few different aspects to the answer. I think, of course, a part of it is the stage of the patient; in other words, is this an early-stage patient, such as stage 1A disease, or is it someone with unfavorable early stage? Or, is it an intermediate-early stage patient who might have four, five, or six sites of disease, but all above the diaphragm? Or, what if it’s a patient with advanced stage disease with bone marrow involvement or even extranodal disease? It’s obviously critical to understand which treatment paradigm the patient will flow through, and I view this somewhat as three different stages: early-stage favorable, early-stage intermediate (or unfavorable as some have classified it), and advanced stage. Probably, the next most important consideration is the patient’s age and their functional status, which is important, of course, in many different lymphomas and cancers, for that matter. In other words, is this a 21-year-old female, or is this is a 78-year-old female who has a performance status of 2? So, these are important factors in delineating the most appropriate route of therapy; should this patient receive standard therapy, or is it someone who might need more modified therapy, such as avoiding, for example, bleomycin in much older patients.

So, I would say the most important factors are the staging, the age, and the patient’s performance status, but we hope to incorporate newer modalities down the road, such as functional image or metabolic tumor burden or, as discussed in another frequently asked question, the micro or mRNA, some of the –omics.  That remains research-based and experimental at this point, but we are hopeful for the future.

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