Haema 2012; 3(3): 239-249
by Maria K. Angelopoulou, Pagona Flevaris, Theodoros P. Vassilakopoulos
National and Kapodistrian University of Athens, Department of Hematology and Bone Marrow Transplantation, “Laikon” General Hospital, Athens, Greece
Abstract
The majority of Hodgin lymphoma patients can be cured with modern chemotherapy combinations with or without radiotherapy. High dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDT/ASCT) is the treatment of choice for young patients (<65 years) who are refractory to or relapse after initial treatment. With this strategy approximately 40-60% of refractory/relapsed Hodgkin lymphoma patients can be cured. Salvage chemotherapy given before HDT/ASCT aims to disease control and peripheral blood stem cell mobilization and collection. For this purpose chemotherapy combinations containing cisplatinum, cytarabine, ifosfamide or gemcitabine are administered. The most important prognostic factors for the outcome of HDT/ASCT include the duration of first remission, chemosensitivity to salvage chemotherapy, clinical stage and extranodal disease at relapse. More than 80% of patients without any poor prognostic factors can be cured with HDT/ASCT. On the contrary chemorefractory patients have significantly poorer prognosis, although 15-30% of them can achieve long-term remission. New targeted therapies given either before or after ASCT as consolidation might benefit poor risk patients and are currently under investigation. Disease evaluation by positron emission tomography before ASCT offers new prognostic information and is being evaluated in clinical trials. Older or ineligible patients with primary refractory/relapsed Hodgkin lymphoma are usually treated with conventional salvage chemotherapy with a <30% chance of long-term disease control. Selected patients with localized relapse can be treated with salvage radiotherapy.