The role of transplantation in Hodgkin lymphoma

Abstract

Summary Autologous stem cell transplantation is the standard salvage strategy for young and fit patients with Hodgkin lymphoma failing induction therapy, and is effective in nearly 50% of cases. The quality of response at transplantation is the most relevant prognostic aspect, as patients in complete response can obtain better outcomes. Therefore, first‐line salvage treatments applied before transplantation need to produce high quality responses without excessive myelotoxicity and without affecting peripheral blood stem cell mobilisation. In this sense, the incorporation of new agents active in Hodgkin lymphoma, such as brentuximab vedotin and anti‐programmed death 1 antibodies, in conventional regimens, may help to enhance complete remission rates. Working on conditioning regimen and applying a post‐autologous consolidation treatment (for example with brentuximab vedotin) are two ways for improving transplant outcomes, particularly in patients displaying high‐risk features for early relapse or progression. Allogeneic transplantation maintains its curative potential also in the era of new drugs, although its most correct timing and the most suitable sequence of post‐autologous salvage treatments still remain to be determined.

First salvage treatment with bendamustine and brentuximab vedotin in Hodgkin lymphoma: a phase 2 study of the Fondazione Italiana Linfomi

“…Our results, along with previously reported ones, confirm that BV combinations can be profitably exploited in a first salvage setting, where they permit a timely and effective application of the ASCT phase, when indicated 15,18,22–24,26 . Most of all, in respect of the obtainment of a CMR, which is indeed one of the most predictors of post-ASCT survival 6,9 .…”

“…Under this light, optimization of the outcomes obtained with high-dose regimens and ASCT still remains a priority, which is required to offer the best chance of cure for the largest fraction of patients with refractory and relapsing disease 5 . In particular, any strategy aimed at achieving a minimal disease status, and at specifically obtaining a positron emission tomography (PET)-negative status before ASCT without severe toxicity, would represent a major advance in the overall management of these patients 6–9 .…”

Improving survival of 3760 patients with lymphoma: Experience of an academic center over two decades

“…The survival of HL has improved dramatically over the past 50 years, which was mainly due to the development of chemotherapy regimens and advancement in radiotherapy techniques 11 . Conventional combination of chemotherapy and radiotherapy could cure the majority of patients with newly diagnosed HL, while salvage therapy such as hematopoietic stem‐cell transplantation 12 gave the second chance of cure for patients with relapsed or refractory disease. In a recent study, 13 the 5‐year OS of patients with primary nodal Hodgkin lymphoma and primary extranodal classical were 97.7% and 64.6% during the study period of 2008‐2018.…”

Obesity is associated with an impaired survival in lymphoma patients undergoing autologous stem cell transplantation

“…Baseline patient characteristics displayed no significant differences except for more patients with a progressive disease or stable disease at auto-HSCT in the group of obese patients. This might affect further interpretations of the different groups, especially in light of the fact that remission status at transplantation has been shown to be one of the most relevant indicators of long-term disease control[24, 25]. However, in the multivariate analysis obesity was identified with a clinically relevant hazard ratio (HR 2.618) as an independent risk factor for death, although disease remission status was included into the analysis.…”