Reviewing treatment options for patients with recurrent classical Hodgkin’s lymphoma

This article reviews treatment options for patients with classical Hodgkin's lymphoma (cHL) that came back (relapsed) after chemotherapy. This study found that targeted therapies are becoming more prevalent and that patient outcomes have improved.

cHL is a cancer of white blood cells called lymphocytes. Chemotherapy is effective for most patients with cHL. However, the cancer comes back (relapse) in some patients after initial treatment. For these patients, a stem cell transplant (SCT) is usually the next step. In autologous SCT (autoSCT), healthy stem cells collected from the patient stem cells replace cancer cells. High-dose chemotherapy is also given to get rid of any remaining cancer cells. 

Targeted therapy is another option for relapsed cHL. Brentuximab vedotin (Adcetris; BV) uses antibodies to target lymphoma cells with chemo. Checkpoint inhibitors such as pembrolizumab (Keytruda) help the immune system attack cancer cells. This article reviews different treatment options for patients with relapsed cHL.

Chemotherapy is usually the first treatment for patients with cHL, with or without radiation. The most common regimen is ABVD (adriamycin, bleomycin, vinblastine, dacarbazine). After chemotherapy, more than 80% of patients survive for 10 years without the cancer worsening.

However, some patients do experience relapse after initial chemotherapy. These patients may be good candidates for autoSCT. This type of SCT uses a patient’s stem cells to replace cancer cells with healthy cells. Salvage chemotherapy is usually given first to get rid of any remaining cancer cells. Targeted therapy may also be given. Some studies suggest that targeted therapy may improve transplant outcomes. In a study of 281 patients, 62% of patients had no signs of cancer after treatment with BV and checkpoint inhibitors.

PET scanning is often used after salvage treatment to see how well a patient is responding. A negative PET scan means that there are few to no signs of cancer. 15 – 30% of patients who have negative scan results experience relapse after autoSCT compared to 60 – 75% of patients who have positive scan results (cancer still present).

cHL that returns after autoSCT can be challenging to treat. In one study of 18 patients treated with BV, 75% experienced relapse, while 34% of patients had no signs of cancer. Other targeted therapies may help treat persistent cHL that does not respond to BV. In a study of 37 patients, 69% responded to pembrolizumab (Keytruda), and 22% had a complete response.

This study found that targeted therapies are becoming more prevalent and have helped improve outcomes for these patients.