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

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.