Hodgkin lymphoma: EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up.
- Study type
- Clinical guideline
- Study name
- EHA Hodgkin 2026
- Design
- Clinical guideline of the European Hematology Association (EHA); each recommendation carries a level of evidence and grade of recommendation as a number and letter (e.g. 1A); development method in supplementary appendix S4 of the paper
- Source
- Hemasphere · 2026
In plain words
This European guideline explains how Hodgkin lymphoma is diagnosed and treated. In the early stages, a few short courses of chemotherapy, with radiotherapy if needed, are usually enough, and the chance of cure is high. In the advanced stages, the BrECADD regimen (which contains a targeted drug called brentuximab vedotin) is suggested for younger patients, and the gentler N-AVD regimen (with the immunotherapy drug nivolumab) as an alternative; N-AVD is the preferred approach for older people. The number of courses is often decided by the response on a PET/CT scan. If the disease comes back, treatment includes immunotherapy together with chemotherapy, followed by a transplant of the patient's own stem cells.
Key guideline recommendations
- 1A
Early-stage favourable classic Hodgkin lymphoma should be treated with two cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) followed by 20 Gy involved-site radiotherapy.
- 1A
Early-stage unfavourable classic Hodgkin lymphoma in patients aged 60 or younger should be treated with two cycles of eBEACOPP plus two cycles of ABVD ("2 + 2"), and 30 Gy involved-site radiotherapy should be given only if PET/CT is positive at the end of chemotherapy.
- 1A
If a less intensive approach without eBEACOPP or its procarbazine-free variants is preferred, four cycles of ABVD followed by 30 Gy involved-site radiotherapy should be given.
- 1A
Younger patients with advanced classic Hodgkin lymphoma should be treated with four cycles (if interim PET/CT after two cycles is negative) or six cycles (if interim PET/CT after two cycles is positive) of BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone), followed by PET/CT-guided radiotherapy.
- 1A
If an ABVD-based approach is preferred, six cycles of N-AVD (nivolumab plus doxorubicin, vinblastine and dacarbazine) are an alternative to BrECADD in younger patients with advanced classic Hodgkin lymphoma.
- 2A
In older patients with advanced classic Hodgkin lymphoma who are fit for multi-agent chemotherapy, six cycles of N-AVD should be given.
- 2A
High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is the standard approach for most patients with refractory or relapsed classic Hodgkin lymphoma who are eligible for this treatment.
- 3B
Salvage therapy before HDCT and ASCT should include a PD-1 inhibitor with chemotherapy, either concurrently or sequentially if the response to the PD-1 inhibitor alone is insufficient.
Study population
Adults with classic Hodgkin lymphoma (cHL) in early and advanced stages, relapsed or refractory disease, and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL).
Endpoints
This document is not a trial; it provides recommendations for diagnosis, staging, first-line treatment, treatment of relapsed or refractory disease and follow-up.
Safety and side effects
According to the guideline text, in patients over 60 years bleomycin should be limited to a maximum of two cycles, and in patients over 70 years omission of bleomycin should be considered (3A). Post-treatment surveillance should be planned according to the individual risk of late effects.
Clinical significance and place in guidelines
The 2026 EHA guideline recommends PET-guided BrECADD for advanced classic Hodgkin lymphoma in patients aged 60 or younger, and regards N-AVD as a less intensive alternative in younger patients and the preferred approach in patients over 60; at relapse, salvage therapy containing a PD-1 inhibitor followed by HDCT and ASCT is recommended.
Limitations
Some recommendations (such as the use of a PD-1 inhibitor in salvage therapy before transplantation) are based on lower-level evidence (3B). Details of the evidence-grading method are given in the appendix of the paper. The recommendations were developed for European health systems.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.