Treatment Outcomes of Advanced Stage Classical Hodgkin Lymphoma in the Setting of Vinblastine and Dacarbazine Shortages: A Case Series.

Purpose: Oncology drug shortages have significant implications on patient care, particularly with curative intent therapeutic strategies. This case series highlights strategic management for patients with classical Hodgkin lymphoma (cHL) in the setting of recent dacarbazine and vinblastine shortages without compromising outcomes. Summary: cHL is a highly curable malignancy with initial treatment strategies incorporating chemotherapy, radiation therapy, chemoradiotherapy, or chemoimmunotherapy. The standard of care for patients with cHL includes a backbone of doxorubicin, vinblastine, and dacarbazine (AVD) based therapies in combination with either bleomycin, brentuximab vedotin (BV), or nivolumab. However, in 2023, critical shortages of dacarbazine and vinblastine led to rationing of these agents, raising concerns for a paucity of clear management strategies in patients with cHL. The three patients described in this case series received lower cumulative doses of standard chemotherapy as opposed to alternative therapies without compromising outcomes. Conclusion: Treatment of advanced stage cHL during dacarbazine and vinblastine shortage requires careful consideration of alternative therapies and collaborative effort among healthcare professionals. This case series highlights that with a response-added approach and vigilant monitoring, effective cancer treatment strategies may be implemented despite drug shortages.