Current treatment paradigms for advanced stage Hodgkin lymphoma.

The treatment of advanced classical Hodgkin Lymphoma (cHL) has evolved over the last 50 years with a progressive improvement in long term cure rates in patients up to the age of 60 years. However, a minority of these survivors experience severe morbidity and mortality resulting from intensive chemotherapy and radiotherapy, leading to a drive to de-escalate treatment without compromising survival. The early identification of patients with chemoresistant disease by functional imaging allows the modulation of therapy and an efficient means to test new agents in those most in need of more effective therapy. The outcomes of treatment for older patients have not improved at the same rate, and this group requires a different approach, incorporating specialist geriatric support to personalise therapy. Clinical trials that focus on quality of life, comorbidity and survival are needed to improve survival rates for this expanding population with complex needs.