Hematopoietic Cell Transplantation for Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a highly curable hematologic malignancy with standard chemotherapy regimens; however, for patients with relapsed or refractory disease, outcomes can be poor. Lymphoma refractory to front-line therapy, relapsed within a short period of time after initial therapy, or extranodal relapse are considered high-risk features in most studies that evaluated therapies for patients with relapsed or refractory HL. High-dose chemotherapy with autologous hematopoietic cell transplant remains the main therapy for these patients, with allogeneic hematopoietic cell transplant reserved for relapses after autologous transplant. Maintenance therapy after autologous hematopoietic cell transplant therapy with brentuximab vedotin is an approved therapy that has improved outcomes in a subset of high-risk patients. The role of alternative donor transplantation such as use of haploidentical donors is becoming more popular and has expanded allogeneic transplant as a treatment option for many patients, particularly those who do not have robust representation in the unrelated donor registries. Checkpoint inhibitors and other novel therapies such as brentuximab vedotin and the monoclonal antibody AFM13 continue to add to the treatment armamentarium before and after transplant. In this chapter, we will review and discuss the data behind current therapies and some of the future directions.