Management of Hodgkin Lymphoma - Episode 8

Autologous Transplantation in Hodgkin Lymphoma

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If a patient is eligible, following salvage high-dose chemotherapy, autologous stem cell transplantation is a viable option. If patients do not respond to salvage treatment they become transplant ineligible, Craig H. Moskowitz, MD, suggests. However, transplantation may be an acceptable option following a partial response to salvage therapy.

Approximately 75% of patients with a negative PET scan following a response to salvage chemotherapy are cured by autologous transplantation, Moskowitz notes. Inversely, in the same population, testing positive by PET, cure rates drop to around 37%, suggesting another option may be optimal. However, Moskowitz adds, this does not mean that autologous transplantation is not appropriate, in certain situations, since a portion of patients are still cured.

In some circumstances autologous transplantation may be the best option for a PET positive patient, Jonathan W. Friedberg, MD, suggests, particular if the patient is young and does not have an allogeneic donor. However, he notes, autologous transplantation is not optimal in this setting.

The role of biopsy remains unclear, particularly given the high rate of false positives with PET scan, Lauren C. Pinter-Brown, MD. However, given the nature of the disease, a biopsy at this point may add undue complications, particularly in a patient with active Hodgkin lymphoma, Moskowitz believes. At this point in the treatment, Friedberg notes, a biopsy has recently been performed at recurrence, so another may not be necessary.