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In many cases, earlier lines of treatment can cure Hodgkin lymphoma. However, for patients who become refractory to treatment or relapse after autologous stem cell transplantation (SCT) the prognosis becomes poor warranting a new treatment approach. At this point, allogeneic SCT may be utilized as a late-line treatment in the salvage setting.
In order to receive an allogeneic SCT, a suitable donor must be available and comorbidities should not be present, Lauren C. Pinter-Brown, MD, suggests. Commonly, patients who have failed or are ineligible for autologous SCT will receive allogeneic SCT instead.
In some cases, if a patient has already failed several lines of chemotherapy, it may be more effective to administer an allogeneic rather than autologous SCT, believes Paul A. Hamlin, MD. This treatment decision can be further guided by the location of the disease and the types of previous treatments received, points out Craig H. Moskowitz, MD. Additionally, if a non-chemotherapy agent is administered, this may alter the sensitivity of the tumor, which changes how the treatment decisions are made.
The risks associated with allogeneic SCT are a common roadblock to its utilization. In many cases, the treatment-related mortality at two years is 20% to 30%. Overall, outcomes for allogeneic SCT are surprisingly poor, adds Jonathan W. Friedberg, MD, and, as a result, many patients will not proceed with this treatment. However, patients who experienced a remission during autologous SCT of one year and those in remission 15 to 16 months after autologous SCT have a more favorable outcome to allogeneic SCT, Moskowitz points out.
Most patients who relapse after allogeneic transplant have an exceedingly poor outcome and are generally unable to tolerate further treatment, Friedberg states. At this point, treatment may include additional immunologic manipulation, rapid taper of immunosuppressive medications, and potentially donor lymphocyte infusions. Additionally, novel agents, such as brentuximab vedotin, are acceptable in this space, if the patient has not already received a novel agent.