Table 2.
Transplantation strategies for relapsed/refractory HL
| Transplantation strategies | References |
|---|---|
| ASCT following high-dose chemotherapy is associated with PFS advantage over nontransplant strategies and is considered the standard of care in patients with relapsed or refractory HL who are responding to salvage therapy. | 8,103–108,135–138 |
| A variety of pre-ASCT salvage regimens can be considered and are associated with ORR in approximately two-thirds of patients and CR in approximately one-third of patients. Common regimens include ICE, ESHAP, DHAP, GV, GDV, and more recently BV in sequence or in combination with cytotoxic chemotherapy or PD-1 inhibitors. There is not enough evidence that one regimen is superior to others. | 8,13,73–75,111–120 |
| A variety of myeloablative conditioning regimens are considered acceptable for patients with relapsed or refractory HL undergoing ASCT, most commonly BEAM, CBV, busulfan-based or TBI-based regimens. BEAM may be superior to other conditioning regimens for HL based on retrospective registry data. | 8,106,107,113, 121–134 |
| Pre-ASCT FDG-PET is a major determinant of post-ASCT relapse risk and may be used for risk-adapted treatment design. | 74,113,141,148–152 |
| Frontline ASCT as consolidation for high-risk HL is not associated with a survival benefit. | 154–156 |
| SHDCT is associated with increased toxicity and no survival benefit in patients with relapsed ASCT. | 163 |
| Tandem ASCT may be of some benefit to chemoresistant patients with relapsed or refractory HL, but routine use has not been adopted due to lack of randomized data. | 164–168 |
| BV maintenance post-ASCT is associated with PFS benefit in patients with relapsed or refractory HL undergoing HL with one or more high-risk factors. | 142 |
| Second ASCT may be considered in patients with long remission duration after first ASCT, but data are limited. | 172 |
| alloHCT should be offered to patients who relapse post-ASCT, who are not considered curable with standard chemotherapy, and is associated with long-term disease control in a minority of patients. | 173,174,177–182, 187, 191–199 |
| RIC alloHCT is associated with less TRM and is considered the standard of care, although there is no consensus regarding the optimal conditioning regimen and intensity. | 175–177,180, 184,199 |
| Alternative graft sources (UCBT, haploidentical) are acceptable in patients who lack suitable HLA-matched related or unrelated donors. | 191–198 |
Abbreviations: alloHCT, allogeneic hematopoietic stem cell transplantation; ASCT, autologous stem cell transplantation; BV, brentuximab vedotin; BEAM, carmustine (BCNU), etoposide, cytarabine (Ara-C) and melphalan; CBV, cyclophosphamide, carmustine and etoposide; CR, complete response; DHAP, dexamethasone, cisplatin and cytarabine; ESHAP, etoposide, methylprednisolone, cytarabine and cisplatin; GV, gemcitabine and vinorelbine; GVD, GV with doxorubicin; HL, Hodgkin’s lymphoma; ICE, ifosfamide, carboplatin and etoposide; ORR, overall response rate; PFS, progression-free survival; RIC, reduced intensity conditioning; SHDCT, sequential high-dose chemotherapy; TRM, treatment-related mortality; UCBT, umbilical cord blood transplantation.