This Article Full Text Full Text (PDF) All Versions of this Article: theoncologist.2009-0002v1 14/4/425    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mendler, J. H. Articles by Friedberg, J. W. Search for Related Content PubMed PubMed Citation Articles by Mendler, J. H. Articles by Friedberg, J. W.

Lymphoma

Salvage Therapy in Hodgkin's Lymphoma

James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA

Key Words. Hodgkin • Lymphoma • Relapse • Refractory • Salvage • Transplant

Correspondence: Jonathan W. Friedberg, M.D., University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, New York 14642, USA Telephone: 585-273-4150; Fax: 585-276-0337; e-mail: Jonathan_Friedberg{at}urmc.rochester.edu

Received January 1, 2009; accepted for publication February 13, 2009; first published online in THE ONCOLOGIST Express on April 2, 2009.

Disclosures

Jason H. Mendler: None; Jonathan W. Friedberg: Honoraria: Lilly; Research funding: Cephalon, Millennium.

Section editor George P. Canellos has disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Hodgkin's lymphoma (HL) is a commonly cured malignancy. Unfortunately, patients who are refractory to or relapse after first-line treatment pose a significant therapeutic challenge. There is evidence that these patients are best treated with an approach involving salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (HDCT/ASCT). This approach may result in cure, with better results in patients with low-risk relapse. In patients with high-risk relapse and refractory disease, HDCT/ASCT is rarely curative. More aggressive transplant approaches have shown promising results in this group and are currently under active investigation. For those relapsing after HDCT/ASCT, there exists a range of therapeutic options, including further salvage chemotherapy, reduced-intensity allogeneic transplantation, monoclonal antibody therapy, and novel agents. All patients in this category should be considered for enrollment in clinical trials. This review discusses the evidence behind the current practice in patients with relapsed or refractory HL. Specifically, the efficacy of various salvage chemotherapy regimens, the risk factors influencing outcome with HDCT/ASCT, and the results with alternative transplant approaches, monoclonal antibody therapies, and novel agents are addressed. We conclude by providing our approach to these patients, with the hope that this will serve as a framework for the practicing oncologist.