Interim Positron Emission Tomography-Adapted Treatment Strategies for Classic Hodgkin Lymphoma: Insights From Korean Real-World Data.

BACKGROUND: ABVD chemotherapy (consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine) and positron emission tomography (PET)-guided risk-adapted treatment have improved outcomes in classic Hodgkin lymphoma (cHL), but real-world evidence from Asian populations remains limited. METHODS: We retrospectively analyzed 270 patients with classical Hodgkin lymphoma treated with ABVD at two Korean tertiary centers (2015-2024). Survival analyses were performed on an intention-to-treat basis including all 270 patients. RESULTS: Among end-of-treatment (EOT) evaluable patients (n = 266), the complete response (CR) rate and overall response rate were 89.1% and 95.5%, respectively. With a median follow-up of 58.3 months, the estimated 5-year progression-free survival (PFS) and overall survival (OS) were 81.6% (95% confidence interval [CI], 75.8-86.2%) and 88.8% (95% CI, 83.6-92.4%), respectively. In the interim PET-CR subgroup (n = 200), bleomycin omission (ABVD→AVD) did not impact survival (PFS: P = 0.904; OS: P = 0.290). In multivariate analysis, male sex, an Eastern Cooperative Oncology Group (ECOG) performance status score of ≥ 2 points, and failure to achieve EOT CR were independent predictors of poor PFS, while age ≥ 65 years, extranodal involvement, and non-CR at EOT were associated with inferior OS. CONCLUSION: ABVD with PET-guided modification remains an effective and pragmatic first-line approach for cHL in Korean clinical practice. Real-world outcomes align with clinical trial data, even with limited use of novel agents. These findings support risk-adapted therapy tailored to patient response and regional treatment availability.