Haematology: Early-stage Hodgkin: PET-adapted involved-node RT (H10)
Free question published 07 August 2026
A 24-year-old man with favourable-risk stage IIA classical Hodgkin lymphoma is enrolled on a PET-adapted pathway modelled on the EORTC/LYSA/FIL H10 trial. After two cycles of ABVD his interim PET is negative (Deauville 2). According to the final results of H10, what does omitting involved-node radiotherapy and giving ABVD alone do to his outcome compared with continuing to combined-modality treatment?
- AIt necessitates escalation to BEACOPP to compensate for the omitted radiotherapy
- BIt improves progression-free survival by reducing chemotherapy-related toxicity
- CIt is non-inferior, confirming radiotherapy can be safely omitted in all PET-negative patients
- DIt makes no measurable difference to progression-free survival in the favourable group
- EIt increases the risk of relapse, with the effect most marked in the favourable group
Why E is correct
In the H10 trial, the preplanned interim analysis was titled to reflect that omitting radiotherapy in early-PET-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse. In the final analysis, early-PET-negative favourable patients had a 5-year PFS of 99.0% with ABVD plus involved-node radiotherapy versus 87.1% with ABVD alone, so non-inferiority of chemotherapy alone could not be demonstrated and the relapse risk was greatest in the favourable group.
And why the others are not
- AIncorrect: escalation to BEACOPP applied to PET-positive patients in H10, not PET-negative patients who omit radiotherapy.
- BIncorrect: omitting radiotherapy did not improve PFS; PFS was lower without involved-node radiotherapy.
- CIncorrect: H10 explicitly could not demonstrate non-inferiority of chemotherapy alone in PET-negative patients.
- DIncorrect: in the favourable group the difference was large (99.0% versus 87.1%), not negligible.
Source H10 (EORTC/LYSA/FIL) - PET-adapted treatment in stage I-II Hodgkin lymphoma — Andre MPE, Girinsky T, Federico M, et al. Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol. 2017;35(16):1786-1794. (Interim analysis: Raemaekers JMM, et al. J Clin Oncol. 2014;32(12):1188-1194.)
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