open access

Vol 47, No 1 (2016)
Prace poglądowe / Reviews
Submitted: 2015-09-29
Published online: 2016-01-01
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Early diagnosis and treatment of refractory and recurrent classical Hodgkin's lymphoma

Jan Maciej Zaucha12, Andrzej Deptała34, Renata Zaucha5
DOI: 10.1016/j.achaem.2015.12.001
·
Acta Haematol Pol 2016;47(1):1-9.
Affiliations
  1. Zakład Propedeutyki Onkologii Gdańskiego Uniwersytetu Medycznego, kierownik: prof. dr hab. Wiesław J. Kruszewski, Gdańsk, Polska
  2. Oddział Radioterapii i Onkologii Klinicznej, Gdyńskie Centrum Onkologii, kierownik: dr n. med. Krzysztof Leśniewski-Kmak, Gdynia, Polska
  3. Oddział Onkologii i Hematologii Centralnego Szpitala Klinicznego MSW, kierownik: prof. dr hab. Andrzej Deptała, Warszawa, Polska
  4. Zakład Prewencji Nowotworów Warszawskiego Uniwersytetu Medycznego, kierownik: prof. dr hab. Andrzej Deptała, Warszawa, Polska
  5. Klinika Onkologii i Radioterapii Gdańskiego Uniwersytetu Medycznego, kierownik: prof. dr hab. Jacek Jassem, Gdańsk, Polska

open access

Vol 47, No 1 (2016)
Prace poglądowe / Reviews
Submitted: 2015-09-29
Published online: 2016-01-01

Abstract

Although the prognosis of Hodgkin's lymphoma (HL) is relatively good, about 10% of patients with early and up to 30% with advanced stages do not respond to first line treatment (ABVD) or relapse. The chemoresistance is defined as: the progression of the disease during treatment, lack of complete metabolic response during or after treatment, or the very early <3 months) relapse. At the time of relapse patients can be assigned to three risk groups: high, intermediate and standard. The purpose of second line therapy is to achieve the complete metabolic response consolidated by the high dose chemotherapy and autologous hematopoietic transplantation (auto-HCT). Several different chemotherapy regimens (ICE, DHAP, IGEV, GDP) could be used in the second line. They have a high potential for mobilization of hematopoietic cells and a satisfactory efficacy (50–65%). The optimal number of cycles before the scheduled auto-HCT is 2–4. After the second cycle, the response should be evaluated. If the adequate response is not achieved, chemotherapy should be changed to another non-cross resistant schema. If no response is achieved, the treatment of choice remains brentuximab vedotin, which in Poland is not refunded yet. Alternatively, bendamustine treatment with gemcitabine might be attempted, which is temporarily effective in some patients. Since the prognosis after the relapse after auto-HCT is poor, allogeneic HCT is indicated in such patients. Those who are not candidates for auto/allo-HCT should be offered symptomatic treatment or participation in clinical trials.

Abstract

Although the prognosis of Hodgkin's lymphoma (HL) is relatively good, about 10% of patients with early and up to 30% with advanced stages do not respond to first line treatment (ABVD) or relapse. The chemoresistance is defined as: the progression of the disease during treatment, lack of complete metabolic response during or after treatment, or the very early <3 months) relapse. At the time of relapse patients can be assigned to three risk groups: high, intermediate and standard. The purpose of second line therapy is to achieve the complete metabolic response consolidated by the high dose chemotherapy and autologous hematopoietic transplantation (auto-HCT). Several different chemotherapy regimens (ICE, DHAP, IGEV, GDP) could be used in the second line. They have a high potential for mobilization of hematopoietic cells and a satisfactory efficacy (50–65%). The optimal number of cycles before the scheduled auto-HCT is 2–4. After the second cycle, the response should be evaluated. If the adequate response is not achieved, chemotherapy should be changed to another non-cross resistant schema. If no response is achieved, the treatment of choice remains brentuximab vedotin, which in Poland is not refunded yet. Alternatively, bendamustine treatment with gemcitabine might be attempted, which is temporarily effective in some patients. Since the prognosis after the relapse after auto-HCT is poor, allogeneic HCT is indicated in such patients. Those who are not candidates for auto/allo-HCT should be offered symptomatic treatment or participation in clinical trials.

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Keywords

Hodgkin' s lymphoma; Chemoresistance; Relapse; Second line treatment; Brentuximab vedotin

About this article
Title

Early diagnosis and treatment of refractory and recurrent classical Hodgkin's lymphoma

Journal

Acta Haematologica Polonica

Issue

Vol 47, No 1 (2016)

Pages

1-9

Published online

2016-01-01

Page views

102

Article views/downloads

672

DOI

10.1016/j.achaem.2015.12.001

Bibliographic record

Acta Haematol Pol 2016;47(1):1-9.

Keywords

Hodgkin's lymphoma
Chemoresistance
Relapse
Second line treatment
Brentuximab vedotin

Authors

Jan Maciej Zaucha
Andrzej Deptała
Renata Zaucha

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