American Board of Internal Medicine (ABIM) Certification Practice Exam

Which drug combination is considered the standard of care for all stages of classic Hodgkin lymphoma when chemotherapy is indicated?

1. Doxorubicin and cyclophosphamide

2. Doxorubicin, bleomycin, vinblastine, and dacarbazine

3. ABVD and radiation therapy

4. Rituximab and chemotherapy

The correct answer is: Doxorubicin, bleomycin, vinblastine, and dacarbazine

The standard of care for all stages of classic Hodgkin lymphoma when chemotherapy is indicated is the combination known as ABVD, which includes doxorubicin, bleomycin, vinblastine, and dacarbazine. This regimen has been established through extensive clinical trials as effective for treating Hodgkin lymphoma across various stages. ABVD is favored not only for its efficacy in achieving remission but also for its relatively favorable side effect profile compared to other regimens. Each drug in the ABVD regimen plays a specific role; doxorubicin is an anthracycline that interferes with DNA replication, bleomycin induces DNA strand breaks, vinblastine inhibits mitotic spindle formation, and dacarbazine is an alkylating agent that cross-links DNA. Other options do not represent the recognized standard of care as effectively as the ABVD regimen. For example, the combination of doxorubicin and cyclophosphamide is more commonly used in breast cancer treatment rather than Hodgkin lymphoma. The incorporation of radiation therapy can be part of treatment, but it is typically used in conjunction with ABVD rather than as a standalone or primary therapy. While rituximab has been shown to have efficacy in certain B-cell malignancies, it has