Relapsed/Refractory Hodgkin Lymphoma

For relapsed-refractory Hodgkin Lymphoma, standard therapy consists of salvage chemotherapy followed by autologous stem cell transplantation. Adverse risk factors at relapse include response duration less than 12 months, advanced stage, extranodal disease, “B” symptoms and anemia. There is no obvious superior salvage regimen although maintaining dose-intensity is important for optimal responses. Assessment of response to salvage using FDG-PET identifies a distinct poor risk group, especially those with extranodal disease. Either a second salvage regimen or a tandem autologous transplant may benefit some patients with residual disease post-salvage. Reduced-intensity allografting may provide durable responses for some patients relapsing post-autologous transplant.

Key points

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For RR-HL, standard therapy consists of salvage chemotherapy followed by HDCT/ASCT + RT.
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Key adverse risk factors present at relapse/progression include short response duration <12 months, B symptoms, extranodal disease, as well as advanced stage and anemia.
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There is no obvious superior salvage therapy among the commonly used regimens such as DHAP, ICE, IGEV; maintaining dose-intensity is important for optimal responses.
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Functional imaging using FDG-PET scanning after salvage chemotherapy and before ASCT is a critical predictor of outcome; the goal of salvage should be a negative FDG-PET scan.
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Either a second line of salvage or a tandem ASCT may benefit some patients with residual FDG avidity post-salvage.
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RIC-alloSCT may provide a GVL effect and durable responses in some patients with HL relapsing or progressing after ASCT.
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New agents, particularly Brentuximab vedotin, are being incorporated earlier into the treatment of RR-HL, such as those with FDG-avid chemoresistant disease, those progressing through second-line salvage, or those relapsing after an ASCT.