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Hematol Oncol Stem Cell Ther. 2017 Jun;10(2):47-56. doi: 10.1016/j.hemonc.2016.12.002. Epub 2017 Feb 1.

Relapse of Hodgkin lymphoma after autologous transplantation: Time to rethink treatment?

Author information

1
Division of Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
2
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
3
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: mhamadani@mcw.edu.

Abstract

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.

KEYWORDS:

Allogeneic; Autologous; Hematopoietic cell transplantation; Hodgkin lymphoma; Immunotherapies; Relapse

PMID:
28183681
DOI:
10.1016/j.hemonc.2016.12.002
[Indexed for MEDLINE]
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