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Uptodate Reference Title
Management of HCT-eligible first relapse or refractory classical Hodgkin lymphoma
Management of HCT-eligible first relapse or refractory classical Hodgkin lymphoma
This algorithm describes our approach to the management of first relapse of classical Hodgkin lymphoma (cHL) or primary refractory cHL. All suspected relapses should be confirmed by biopsy. Care of these patients should be coordinated between the primary hematologist/medical oncologist and a hematopoietic cell transplantation specialist. Select patients who have asymptomatic relapse >2 years after initial therapy may be candidates for chemotherapy (with or without radiation) without subsequent autologous HCT. Further details are presented in UpToDate content on the treatment of relapsed or refractory Hodgkin lymphoma.
cHL: classical Hodgkin lymphoma; CR: complete response, Deauville 1-3; PR: partial response, Deauville 4-5; PD: progressive disease, by PET/CT or clinical evaluation; ICE: ifosfamide, carboplatin, etoposide; GVD: gemcitabine, vinorelbine, pegylated liposomal doxorubicin; DHAP: dexamethasone, cytarabine, cisplatin; HCT: hematopoietic cell transplantation; BV: brentuximab vedotin; RT: radiation therapy. * Experts differ regarding preferred salvage chemotherapy and number of treatment cycles. The most common options include ICE, GVD, and DHAP. We prefer two cycles of ICE as our initial salvage chemotherapy. We offer GVD as a second-line salvage regimen for those who require additional chemotherapy treatment. ¶ Options include targeted chemotherapy (eg, brentuximab vedotin) or immune checkpoint blockade. Δ Involved site RT (preferred) or involved field RT; second-line salvage chemotherapy or brentuximab vedotin are acceptable alternatives in this setting, especially if radiation therapy is expected to result in significant short-term or long-term toxicity. ◊ PET/CT is performed to exclude PD (ie, new activity outside of the radiation port), but PET may remain positive within the port due to inflammation-associated activity. § Involved site radiation therapy may be administered prior to HCT, after achieving CR with alternative salvage chemotherapy. ¥ BV improves progression free survival (but not overall survival) in patients with primary refractory disease, early relapse (ie, <12 months after initial treatment), or extranodal involvement in patients who did not previously receive BV; a decision to treat must also consider the high incidence of neuropathy associated with BV.
