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Haematology: Early-stage Hodgkin: combined-modality vs PET-adaptation (RAPID synthesis)

Free question published 12 October 2026

HaematologyEarly-stage Hodgkin: combined-modality vs PET-adaptation (RAPID synthesis)

A 23-year-old woman with stage IA classical Hodgkin lymphoma in a single supraclavicular node completes three cycles of ABVD. Her end-of-chemotherapy FDG-PET is positive at Deauville 4. Her care follows the RAPID trial design. According to the way RAPID managed PET-positive patients, what should she be offered now?

  1. ASwitch to six cycles of escalated BEACOPP
  2. BInvolved-field radiotherapy alone with no further chemotherapy
  3. CImmediate high-dose chemotherapy with autologous stem-cell rescue
  4. DNo further treatment, because three cycles of ABVD are sufficient for stage IA disease
  5. EA fourth cycle of ABVD followed by consolidation radiotherapy

Why E is correct

In the RAPID trial only PET-negative patients were randomised to radiotherapy or no further treatment. PET-positive patients (a worse-prognosis group) were treated off the randomisation with a fourth cycle of ABVD plus consolidation radiotherapy, reflecting the principle that a positive end-of-chemotherapy PET warrants treatment intensification rather than de-escalation.

And why the others are not

  • AIncorrect: escalated BEACOPP is not the RAPID pathway for early-stage PET-positive disease; the trial used a further ABVD cycle plus radiotherapy.
  • BIncorrect: radiotherapy alone without completing chemotherapy was not the RAPID approach for PET-positive patients.
  • CIncorrect: autologous transplant is salvage for relapsed or refractory disease, not first-line management of an end-of-chemotherapy PET-positive early-stage patient.
  • DIncorrect: stopping after three cycles is the de-escalation strategy tested only in PET-negative patients, not in a PET-positive patient.

Source RAPID - PET-directed therapy for early-stage Hodgkin's lymphoma — Radford J, Illidge T, Counsell N, et al. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015;372(17):1598-1607.

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