27-year-old male patient who presented in 2023 with no past medical history other than cigarette use who presented a few weeks after a relatively mild COVID infection with palpable right inguinal and left axillary adenopathy. Node excisional biopsy demonstrated Hodgkin's disease, and his staging PET-CT and bone marrow aspiration biopsy was consistent with stage III disease. He had a DLCO of 50% on PFTs with no parenchymal lung abnormalities on CT imaging. He began A+AVD and has done well with interim resolution of adenopathy on CT imaging after cycle IIB. We were unable to obtain vinblastine for cycle IIIA, and we are still awaiting availability. He is due for cycle IIIB. Should I just continue his current treatment without vinblastine until anticipated availability of vinblastine later this month? Or substitute another medication or change regimen?
I would try a local referral to try and get the drug. If not available then I would continue the regimen as is with no replacement and then reintroduce the vinblastine when available. I am not aware of any available regimens to replace vinblastine safely. A recent retrospective review in ASCO 2023 showed that patients with dose reductions/elimination of vinblastine or BV due to PN had comparable outcome to whats reported in ECHELON-1 so hopefully efficacy not majorly affected. Here is the poster https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.7542
