title: [Treatment and prognosis of relapsed or refractory Hodgkin lymphoma patients ineligible for stem cell transplantation].
abstract: BACKGROUND
  Relapses occur in 20-30% of patients with Hodgkin lymphoma (HL). Currently, there is no widely accepted standard treatment strategy in relapsed/refractory HL patients ineligible for autologous stem cell transplantation (ASCT). This article retrospectively evaluates survival and prognosis of patients with relapsed/refractory HL who were not suitable for high-dose chemotherapy and ASCT. New drugs and their efficacy in this indication are also disscussed.
  
  
  METHODS
  A total of 17 patients treated with at least three lines of standard chemotherapy ± radiotherapy were analysed. High-dose chemotherapy and ASCT was not indicated due to advanced age (seven patients), chemorefractory disease (seven patients), cardiotoxicity (two patients) and insufficient stem cell collection of CD34+ cells (one patient).
  
  
  RESULTS
  Median follow-up of the whole group after establishing the diagnosis was 3.48 years. Overall response to the second-line treatment was achieved in eight patients (47.0%). Four patients (23,5%) were classified as primary refractory after the first-line treatment and three more chemorefractory patients (17,6%) were detected after the second-line treatment. Out of 17 patients four are still alive (23,5%) in remission and 13 have died (eight due to HL progressions, four due to toxicity of the treatment and one patient with unknown cause of death). The estimated 5-year overall survival from the time of initial diagnosis was 46.3% and 30.8% when counted from the diagnosis of the first relapse. The estimated 5-year overall survival of four primary chemorefractory patients was significantly worse when compared to the group of 13 relapsed patients: 0 vs. 60.6%, p < 0,001.
  
  
  CONCLUSIONS
  Prognosis of relapsed/refractory HL patients ineligible for ASCT and treated with several lines of standard chemotherapy ± radiotherapy is poor. Brentuximab vedotin is indicated in primary refractory patients in the second-line settings and in other relapsed patients in the third-line treatment. This strategy would help to increase the number of remissions, hence achieving a higher survival rate.
authors.forename: H
authors.initials: H
authors.lastname: Móciková
authors.forename: A
authors.initials: A
authors.lastname: Sýkorová
authors.forename: P
authors.initials: P
authors.lastname: Stěpánková
authors.forename: J
authors.initials: J
authors.lastname: Marková
authors.forename: J
authors.initials: J
authors.lastname: Michalka
authors.forename: Z
authors.initials: Z
authors.lastname: Král
authors.forename: L
authors.initials: L
authors.lastname: Burešová
authors.forename: D
authors.initials: D
authors.lastname: Belada
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
chemical_list: D000970:Antineoplastic Agents