Should all patients with HL who relapse after ASCT be considered for allogeneic SCT? A consult, yes; A transplant, not necessarily

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Abstract

Lymphoma experts in the United States have changed the way Hodgkin lymphoma (HL) is managed in the curative setting; this has implications on treatment of the heavily pretreated patient. This is highly relevant in a few important circumstances: the lack of enthusiasm for any radiotherapy (RT) in early-stage disease for patients without bulky disease, and the use of brentuximab vedotin (BV) in the salvage setting despite limited evidence of a survival advantage compared with chemotherapy-only salvage regimens. Last, the fate of upfront therapy for advanced stage HL will be dependent on the results of the phase 3 Frontline Therapy Trial in Patients With Advanced Classical Hodgkin Lymphoma, which compared doxorubicin, bleomycin, vinblastine, and dacarbazine to BV-adriamycin, vinblastine, and dacarbazine. Preliminary data suggest a 6% improvement in the experimental arm at 2 years; whether this leads to a new standard of care is debatable. For patients in which high-dose therapy and autologous stem cell transplantation (ASCT) has failed, treatment options for these healthy young patients was some type of bridging therapy to a potentially curative nonmyeloablative allogeneic transplant (NMT) provided this bridging therapy shrinks the HL to a minimal disease state. If achieved, reports in the literature suggest that 30% to 60% of patients achieve long-term event-free survival. However, in 2017, we have an array of treatment options for these patients and the kneejerk response is questionable.1-3

Original languageEnglish (US)
Pages (from-to)821-824
Number of pages4
JournalBlood Advances
Volume2
Issue number7
DOIs
StatePublished - Apr 10 2018

ASJC Scopus subject areas

  • Medicine(all)

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