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Haematology: Advanced Hodgkin: interim-PET-positive escalation (RATHL)

Free question published 23 October 2026

HaematologyAdvanced Hodgkin: interim-PET-positive escalation (RATHL)

A 38-year-old man with stage IVB classical Hodgkin lymphoma receives two cycles of ABVD as part of an interim-PET-response-adapted treatment pathway. His interim PET-CT is positive at Deauville 5. He is otherwise fit. What is the most appropriate management of his remaining treatment?

  1. AOmit bleomycin and continue AVD for cycles 3 to 6
  2. BEscalate to BEACOPP
  3. CProceed directly to autologous stem-cell transplant
  4. DStop chemotherapy and give involved-site radiotherapy to all initial sites
  5. EContinue ABVD unchanged for cycles 3 to 6

Why B is correct

In RATHL, patients with a positive interim PET after two cycles of ABVD were intensified to BEACOPP (either escalated BEACOPP or BEACOPP-14), achieving a 3-year PFS of 67.5%. A positive interim scan therefore prompts escalation, the opposite of the de-escalation to AVD used in PET-negative patients.

And why the others are not

  • AIncorrect: omitting bleomycin (AVD) is the de-escalation strategy for PET-negative patients, not PET-positive patients.
  • CIncorrect: autologous transplant is reserved for relapsed or refractory disease, not first-line interim-PET-positive escalation.
  • DIncorrect: radiotherapy alone does not replace systemic intensification for advanced PET-positive disease.
  • EIncorrect: continuing unchanged ABVD ignores the adverse prognostic information of a positive interim PET; RATHL escalated these patients.

Source RATHL - Response-adapted therapy guided by interim PET in advanced Hodgkin lymphoma — Johnson P, Federico M, Kirkwood A, et al. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma. N Engl J Med. 2016;374(25):2419-2429.

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