What is the treatment for relapsed Hodgkin lymphoma (Hodgkin disease)?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Patients with Hodgkin lymphoma who have never entered complete remission (CR), or whose disease has relapsed after the attainment of CR, have a very poor prognosis when treated with standard chemotherapy and radiation. Therefore, high-dose chemotherapy with autologous stem cell transplantation is recommended for these patients. [91]

In this procedure, salvage chemotherapy is first administered to help reduce the size of the persistent disease and obtain CR, if possible. The number of cycles to be administered depends on how well the disease is responding to therapy. An optimal situation is one in which the disease enters CR with negative positron emission tomography (PET) scan findings, although one study demonstrated that patients may achieve long-term disease-free survival even if their condition has little or no response. [92]

Following one of the cycles of salvage chemotherapy, hematopoietic stem cells are collected from the peripheral blood by leukapheresis and are stored frozen. Following the administration of myeloablative chemotherapy (eg, BEAM), the stored hematopoietic stem cells are thawed and reinfused into the patient to facilitate hematopoietic recovery. High-dose chemotherapy (HDC) with autologous stem cell transplantation can provide better than 50% long-term, progression-free survival for patients with relapses, although specific predicted outcomes vary widely depending on patient-specific risk factors.


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