Relapsed and refractory hodgkin lymphoma

Abstract

High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is the standard treatment for patients with relapsed or refractory Hodgkin lymphoma (HL). This is based on two randomized controlled studies that showed better event-free survival (EFS) in those treated with ASCT as compared to standard-dose salvage chemotherapy. Several risk factors have been identified in HL patients receiving HDCT and ASCT including time to recurrence of HL, stage at relapse, and response to salvage therapy (SC) before HDCT. More recently, pre-ASCT positron emission tomography has been established as a powerful prognostic tool in relapsed HL. Patients with recurrent HL receive SC before the final myeloablative HDCT by default. However, neither SC nor HDCT regimens have thus far been compared in randomized trials so that the treating clinician has the choice between different regimens. In addition, radiotherapy before, during, and after ASCT as well as tandem ASCT was evaluated to improve the prognosis. So far, there is no role for maintenance therapy in this setting, but a phase III randomized placebo-controlled trial using brentuximab vedotin as maintenance therapy has been fully recruited and results are pending. Other ongoing trials incorporate new drugs into the SC regimens to increase the cure rates. Currently, allogeneic transplant is an option only for a small minority of relapsed/refractory HL patients.