Intensified chemotherapy regimens work better in people with Hodgkin lymphoma, though patients face an increased risk of secondary acute myeloid leukemia, according to a Cochrane review of 16 trials involving nearly 3,000 individuals. The trials compared 1) chemotherapy with or without additional radiotherapy; 2) a more extensive or more restricted radiation field; 3) higher or lower radiation dose; 4) more or fewer courses of chemotherapy; and 5) standard-dose or dose-intensified chemotherapy. Among the findings:

• Chemotherapy without additional radiotherapy was linked with a lower second cancer risk but also possibly more disease growth/regrowth.
• Second cancer risk, overall survival, and Hodgkin-free survival was similar regardless of the radiation field treated.
• The same was true when comparing 1) chemotherapy with lower- vs higher-dose radiation and 2) fewer vs more courses of chemotherapy.
• Dose-intensified chemotherapy improved Hodgkin-free survival, but increased the risk of secondary leukemia.
• While intensified chemotherapy’s impact on overall survival was not conclusive, escalated-dose BEACOPP seemed to lengthen survival.