Relapse of Hodgkin lymphoma after autologous transplantation: Time to rethink treatment?
Relapse of Hodgkin lymphoma after autologous hematopoietic cell transplantation (autologous HCT) is a major therapeutic challenge. Its management, at least in younger patients, traditionally involves salvage chemotherapy aiming to achieve disease remission followed by consolidation with allogeneic hematopoietic cell transplantation (allogeneic HCT) in eligible patients. The efficacy of salvage therapy is variable and newer combination chemotherapy regimens have improved the outcomes. Factors such as shorter time to relapse after autologous HCT and poor performance status have been identified as predictors of poor outcome. Newer agents such as immunoconjugate brentuximab vedotin, checkpoint inhibitors (e.g., pembrolizumab, nivolumab), lenalidomide, and everolimus are available for the treatment of patients relapsing after autologous HCT. With the availability of reduced intensity conditioning allogeneic HCT, more patients are eligible for this therapy with lesser toxicity and better efficacy due to graft versus lymphoma effects. Alternative donor sources such as haploidentical stem cell transplantation and umbilical cord blood transplantation are expanding this procedure to patients without HLA-matched donors. However, strategies aimed at reduction of disease relapse after reduced intensity conditioning allogeneic HCT are needed to improve the outcomes of this treatment. This review summarizes the current data on salvage chemotherapy and HCT strategies used to treat patients with relapsed Hodgkin lymphoma after prior autologous HCT.
Division of Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Yogesh
Y
Jethava
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Guru Subramanian
GS
Guru Murthy
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: mhamadani@mcw.edu.
Mehdi
M
Hamadani
D000328:Adult; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006689:Hodgkin Disease / Q000209:etiology*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult; D000093542:Gemcitabine
D003841:Deoxycytidine; D000093542:Gemcitabine
Allogeneic; Autologous; Hematopoietic cell transplantation; Hodgkin lymphoma; Immunotherapies; Relapse