January 21, 2015

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The standard of care for an individual with Hodgkin lymphoma who fails induction chemotherapy is salvage chemotherapy followed by stem cell transplant, states Robert W. Chen, MD. Patients who are candidates for transplant should have low disease burden and be in a state of either complete remission or good partial remission. Patients who do not achieve remission with salvage chemotherapy may receive a tandem autologous stem cell transplant (ASCT), where a mini transplant is first given to debulk the patient, followed by a second transplant to consolidate the response.

An abstract presented at the 2014 ASH Annual Meeting demonstrated long-term progression free survival (PFS) and a good 2-year overall survival (OS) with tandem ASCT primary progressive or recurrent Hodgkin lymphoma, notes Chen. In the study, the 2-year PFS rate was 63% and 2-year OS rate was 91% at a median follow-up of 5.4 years. The authors of the study suggested that the high OS rate seen in this study could be attributed to available treatment strategies for patients after ASCT, including brentuximab vedotin.For patients with lymphoma, an autologous transplant can safetly be given, since the disease does not tend to affect an individual’s bone marrow, Chen suggests. Allogeneic stem cell transplant is commonly administered for individuals who have failed autologous transplant. Candidates for an allogeneic transplant should have good organ function and a readily available donor, Chen notes. While allogeneic transplant can be used to cure a small subset of patients, it is not completely effective and has its own risks, suggesting that it should be used sparingly.