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Treatment Options in Relapsed/Refractory Hodgkin Lymphoma

Insight from: John Sweetenham, MD, Huntsman; Robert W. Chen, MD, City of Hope;and Anas Younes, MD, MSK 
Published: Wednesday, Mar 04, 2015
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Second-line therapy is commonly followed by autologous transplant for transplant eligible patients with relapsed and refractory Hodgkin lymphoma (HL), explains Anas Younes, MD. Candidates eligible for transplant are typically younger patients with no other comorbidities. The most widely used salvage therapies are platinum-based regimens, ICE (ifosfamide, carboplatin, and etoposide) and DHAP (dexamethasone, high dose cytarabine, and cisplatin), and gemcitabine-regimens, GEMOX (gemcitabine and oxaliplatin) and IGEV (ifosfamide, gemcitabine, and vinorelbine).

The goal in relapsed and refractory disease, regardless if it is second-line treatment or third-line treatment, is achieving remission and then taking the patient to transplant—the only potentially curative regimen for this patient population, explains Younes.

There are a number of pretransplant risk factors in patients with HL that predict subsequent outcomes, according to John Sweetenham, MD. Retrospective studies conducted with patients undergoing transplantation for HL revealed that patients with primary refractory disease appear to fare worse. In general, individuals who relapse within 1 year of their initial chemotherapy are generally regarded as being a poor-risk group. Sweetenham explains that more recent data suggest that people who relapse within the first 3 months are a particularly high-risk population.
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For High-Definition, Click
Second-line therapy is commonly followed by autologous transplant for transplant eligible patients with relapsed and refractory Hodgkin lymphoma (HL), explains Anas Younes, MD. Candidates eligible for transplant are typically younger patients with no other comorbidities. The most widely used salvage therapies are platinum-based regimens, ICE (ifosfamide, carboplatin, and etoposide) and DHAP (dexamethasone, high dose cytarabine, and cisplatin), and gemcitabine-regimens, GEMOX (gemcitabine and oxaliplatin) and IGEV (ifosfamide, gemcitabine, and vinorelbine).

The goal in relapsed and refractory disease, regardless if it is second-line treatment or third-line treatment, is achieving remission and then taking the patient to transplant—the only potentially curative regimen for this patient population, explains Younes.

There are a number of pretransplant risk factors in patients with HL that predict subsequent outcomes, according to John Sweetenham, MD. Retrospective studies conducted with patients undergoing transplantation for HL revealed that patients with primary refractory disease appear to fare worse. In general, individuals who relapse within 1 year of their initial chemotherapy are generally regarded as being a poor-risk group. Sweetenham explains that more recent data suggest that people who relapse within the first 3 months are a particularly high-risk population.
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