What are the treatment options for Hodgkin lymphoma that relapses or does not respond to treatment?

This review outlines the treatment options for Hodgkin lymphoma that has relapsed or that did not respond to treatment. 

Standard treatment for Hodgkin lymphoma is a combination of chemotherapy and radiation. More than 80% of patients achieve long-term cure with these treatments. Some patients do not respond to the original treatment (known as refractory disease). In other patients the cancer returns (relapses) after a period without disease. Different options are used in the treatment of these patients. Most will undergo high-dose chemotherapy followed by stem cell transplant. Stem cells are immature blood cells. Patients will also be treated with salvage chemotherapy. This is regular-dose chemotherapy delivered before the high-dose chemotherapy. Salvage treatment can help to shrink the areas of cancer.

The current article reviews the standard treatment options for refractory or relapsed Hodgkin lymphoma. Newer treatment options are also explored.

The ICE chemotherapy combination is often used as a salvage treatment. This includes ifosfamide, carboplatin, and etoposide. Trials have shown a response rate of close to 80%. The tumors disappeared in 50% (a complete response). Other chemotherapy combinations are also under investigation.

Brentuximab vedotin (Adcetris) is a combination of a chemotherapy and antibody (a protein). The protein targets cancer cells and the chemotherapy stops them from growing and dividing. This treatment has been explored as a salvage treatment. In patients who saw a complete response with brentuximab treatment, 80% were cancer progression free after 2 years.

High-dose chemotherapy is generally delivered before a stem cell transplant. One study compared high-dose chemotherapy to standard chemotherapy (using a combination of carmustine, etoposide, cytarabine, melphalon, and dexamethasone). The 3-year freedom from treatment failure rate was significantly higher with high-dose chemotherapy (55%) compared to standard (34%).

The success of a stem cell transplant can depend on how well the cancer responds to salvage therapy. Other factors include advanced cancer stage, relapse within 12 months, and symptoms such as night sweats, weight loss, and fever.

A PET scan is an imaging technique that uses a radioactive substance to image the organs and tissue within the body. This type of scan can help evaluate response to treatment. One study noted that patients with cancer activity on a PET scan after salvage therapy had 5-year progression free rates of 30%. 75% of patients without activity on a PET scan were progression free after 5 years.

Some patients may have their cancer recur after a stem cell transplant. This can be more difficult to treat. Brentuximab has shown some success in these patients. The estimated 5-year survival rate in one trial was 41%. 

This article highlighted the treatment options available to patients with refractory or relapsed Hodgkin lymphoma.