Abstract
Autologous hematopoietic stem cell transplant (auto-HSCT) remains the cornerstone for relapsed and refractory Hodgkin lymphoma (HL) as well as patients with primary induction failure HL. Chemosensitive disease has better outcomes, and attaining a positron emission tomography (PET)-negative response before autologous transplant portends better overall survival (OS) and progression-free survival (PFS). The goal of salvage chemotherapy is to perform optimal cytoreduction before auto-HSCT with the least amount of toxicity. More intensive conditioning regimens have shown improved PFS and OS in phase II trials; however, randomized trials need to be explored in larger setting. Radiation therapy can improve disease control in the peri-auto-HSCT period for bulky disease and residual PET-positive disease. Maintenance therapy should be studied in clinical trials; however, for high-risk patients, brentuximab maintenance is now the standard. Allogeneic HSCT can provide a durable remission for patients who relapse after autologous HSCT and however can have significant complications associated with graft-versus-host disease and infection associated with immune suppression. Long-term side effects secondary to transplant remain an important issue that require careful follow-up and monitoring.
Original language | English (US) |
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Title of host publication | Hematopoietic Cell Transplantation for Malignant Conditions |
Publisher | Elsevier |
Pages | 231-243 |
Number of pages | 13 |
ISBN (Electronic) | 9780323568029 |
ISBN (Print) | 9780323568036 |
DOIs | |
State | Published - Jan 1 2019 |
Keywords
- Allogeneic transplant
- Autologous transplant
- Intensive conditioning regimens
- Maintenance after transplant
- Salvage chemotherapy
ASJC Scopus subject areas
- General Medicine