Hodgkin's Lymphoma

Hodgkin's lymphoma is an uncommmon lymphoma with a bimodal age distruction with the first peak between ages 15 and 35 and the second peak after 55 years or older. Older patients have difficulty tolerating the multi-agent chemothearpy. The same regimen ABVD has been used for 40 years as pioneered by Bonadonna until Brentuximab-CHP was shown to be slightly more effective at curing patients with stage III or IV disease. Howeever, in that trial (ECHELON-1, Ansell, S. NEJM 2022;387:310-20), the overall 6 year survival in patients receiving standard ABVD was still 89.4% which is excellent.

This excellent 6 year outcome does not translate into patients treated in lower resource countries for many reasons. Some of those reasons include access to diagnostic testing, but also access to affordable chemotherapy, chemotherapy that is now generic and low cost in the US and the Western world.

There are approximately 8570 new cases of Hodgkin's lymphoma in the US each year (see here) and extrapolating that to the 7 billion patients world wide gives rise to an estimated 166,000 cases world-wide each year. Most cancer patients treated world-wide are treated through public cancer hospitals which struggle with the high costs of cancer care.

There is data (see here) suggesting that bleomycin can maintain most of its potency if stored out of direct sunlight for less than 4 weeks at room temperature. There is similar data for vinblastine (see here) and dacarbazine as well. (see here) This was the standard method of storage during Bonadonna's time and for decades after.