Salvage Therapy for Hodgkin’s Lymphoma: A Review of Current Regimens and Outcomes

Abstract

Luca Castagna,1 Armando Santoro,1,2 Carmelo Carlo-Stella1,2 1Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy; 2Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, ItalyCorrespondence: Luca CastagnaHumanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, Milan 20089, ItalyEmail [email protected]: Relapse/refractory Hodgkin lymphoma patients are still a clinical concern. Indeed, despite more effective first-line chemotherapy regimens and better stratification of unresponsive patients by clinical factors and use of early PET, roughly one-third of such patients need salvage chemotherapy and consolidation with high-dose chemotherapy. In this paper, the authors review the different salvage treatments, with special emphasis on newer combinations with brentuximab vedotin or check point inhibitors. The overall response rate is constantly increasing, with a complete remission rate approaching 80%. Functional response evaluation by PET imaging is a strong predictive factor of longer survival, and more sophisticated tools, such as detection of circulating tumour DNA, are emerging to refine the disease-status assessment after treatment. Consolidation by high-dose chemotherapy is still considered the standard of care in chemosensitive patients, leading to a high fraction of patients towards long-term disease control. Maintenance therapy with BV is now approved, reducing disease relapse/progression. An increasing number of Hodgkin lymphoma patients will be cured after first- and second-line therapy, and long-term toxicity needs to be continuously assessed and avoided.Keywords: Hodgkin lymphoma, refractory/relapsed disease, checkpoint inhibitors, brentuximab vedotin, high-dose chemotherapy

Keywords

• hodgkin lymphoma
• refractory/relapsed disease
• checkpoint inhibitors
• brentuximab vedotin
• high-dose chemotherapy