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Transplant strategies in relapsed/refractory Hodgkin lymphoma

Gunjan L. Shah and Craig H. Moskowitz

Abstract

The majority of patients with Hodgkin Lymphoma (HL) are cured with initial therapy. However, high dose therapy with autologous hematopoietic cell transplant (AHCT) allows for the cure of an additional portion of patients with relapsed or primary refractory disease (rrHL). PET negative complete remission (CR) prior to AHCT is critical for long-term disease control. Several salvage options are available with comparable response rates, and the choice can be dependent of comorbidities and logistics. Radiation therapy can also improve the remission rate and is an important therapeutic option for selected patients. BV maintenance after AHCT is beneficial in patients at high risk for relapse, especially those with more than one risk factor, but can have the possibility of significant side effects, primarily neuropathy. Newer agents with novel mechanisms of action are under investigation to improve response rates for patients with subsequent relapse, though are not curative alone. BV and the checkpoint inhibitors nivolumab and pembrolizumab are very effective with limited side effects and can bridge patients to curative allogeneic transplants (allo HCT). Consideration for immune mediated toxicities, the timing of allo HCT based on response, and the potential for increased graft versus host disease remain important. Overall, prospective investigations continue to improve outcomes and minimize toxicity for rrHL patients.

  • Submitted September 7, 2017.
  • Accepted November 28, 2017.