HODGKINS-DISEASE - THE NEXT DECADE

Although treatment of Hodgkin's disease has been extensively studied i n the past, fewer clinical studies are being reported, despite the fac t that the optimal therapy for each stage has not yet been established . The pathologic subtypes have not been officially changed for years, although lymphocyte-predominant disease may be unrelated to the other subtypes, lymphocyte depleted histology may really be a T-cell large-c ell lymphoma, mixed cellularity represents a spectrum of disease, and some cases remain unclassifiable. Staging has also still not been comp letely standardized, mainly because of reliance on the lymphangiogram and the staging laparotomy, which are being less commonly performed fo r treatment planning. Investigators still question the value of the ga llium scan, magnetic resonance imaging, and abdominal ultrasound for t reatment planning, and the role of these tests in the era of managed c are is not defined. Finally, because treatment for the disease is so e ffective, the merit of each treatment plan may eventually be weighed i n terms of emotional, social, and financial costs to the patient. For patients with early-stage (I-II) disease, only limited toxicity is acc eptable; for patients with bulky stage II or stage III disease, combin ed modality therapy must be considered standard therapy, but investiga tors must find ways to lessen toxicity of radiotherapy and intensive c hemotherapy. Finally, for patients with stage IV disease, ongoing stud ies of patients at high risk of relapse may reveal which will benefit from bone marrow or peripheral stem-cell transplantation as initial th erapy.