# RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma

Source: https://nuclide.cc/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/  
Nuclide record `paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016` (Key paper). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Using a PET scan after two cycles to decide the rest of treatment let patients with a clear scan drop bleomycin, sparing their lungs without losing cure, while those with a positive scan were escalated to stronger chemotherapy.

## Summary

International randomised trial of 1,214 patients with advanced Hodgkin lymphoma who had an interim PET-CT after two cycles of ABVD; PET-negative patients were randomised to continue ABVD or switch to AVD (omitting bleomycin), and PET-positive patients were escalated to BEACOPP.

Three-year progression-free survival was 85.7 percent with ABVD and 84.4 percent with AVD, with fewer pulmonary adverse events after bleomycin was dropped; PET-positive patients escalated to BEACOPP had a three-year progression-free survival of 67.5 percent, better than expected. PET-adapted therapy became standard.

## Fields

- Kind: Key paper
- Last checked: 2026-09-18
- Journal: New England Journal of Medicine
- Year: 2016
- DOI: 10.1056/NEJMoa1510093
- Authors: Johnson P, Federico M, Kirkwood A, et al.
- Findings: Three-year progression-free survival 85.7 percent with continued ABVD versus 84.4 percent with AVD after a negative interim PET.; Fewer pulmonary and other toxic effects without bleomycin; PET-positive patients escalated to BEACOPP had 67.5 percent three-year progression-free survival.
- What it means: An interim PET scan after two cycles guides treatment of advanced Hodgkin lymphoma: drop bleomycin if negative, intensify if positive.
- Caveats: The non-inferiority margin for AVD was not formally met in the intention-to-treat analysis, though the difference was small.; Predates brentuximab vedotin and nivolumab combinations, which now often replace ABVD.

## Sources

- N Engl J Med 2016: https://doi.org/10.1056/NEJMoa1510093
- PubMed: https://pubmed.ncbi.nlm.nih.gov/27332902/

## Connected records

- trials: [RATHL](https://nuclide.cc/trials/rathl/)
- journals: [New England Journal of Medicine](https://nuclide.cc/journals/nejm/)
- pairings: [FDG PET then response-adapted chemotherapy](https://nuclide.cc/pairings/fdg-pet-response-adapted-therapy/)

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