What is the Best Option to Cure Patients with Resistant/Relapsing Hodgkins Disease?

Massimo      Magagnoli; Monica      Balzarotti; Luca      Castagna; Monica      Demarco; Armando      Santoro

Abstract

Nearly 80% of patients with Hodgkins disease (HD) are cured with chemotherapy with or without radiotherapy. However, in patients with primary refractory or relapsed disease, high-dose therapy (HDT) and autologous or peripheral-blood stem-cell transplantation (ASCT or PBSCT) represents the best curative option. Several prognostic factors to identify patients at high risk for relapse or progression have been analyzed. However, in almost all analyzed series, disease status before high-dose chemotherapy with PBSC support remains the most important factor predicting the outcome of these patients. Nonetheless, the benefit of cytoreduction before HDT has yet to be fully determined and efforts to identify the best active regimen, combining therapeutic activity and CD34+ stem-cell mobilizing potential, represent a challenging issue for these patients. Furthermore new approaches like myeloablative and non-myeloablative allogeneic transplants have been assessed to improve long-term in such patients. In this review we analyzed the results of the most important salvage chemotherapy combinations as well as allogeneic transplantations to clarify the optimal treatment options for patients with resistant/relapsing HD.

Keywords: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), CEP regimen, allogeneic transplantation, graft versus Hodgkins lymphoma (GVHL), chemotherapy

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