Topics:
Hematologic Malignancies • Medical Oncology • Bone Marrow Transplant • Hodgkin Lymphoma • Hematology
What is your approach in a transplant-eligible patient with relapsed classical Hodgkin lymphoma who has an area of refractory disease after salvage chemotherapy?
Would you still proceed to high-dose therapy and autologous SCT?
Would you incorporate radiation pre- or post- transplant? Or offer additional salvage systemic therapy prior to auto SCT?
Answer from: Medical Oncologist at Academic Institution
The goal here, especially in Hodgkin's lymphoma, is to achieve complete metabolic remission (CMR) by PET before high dose chemotherapy and autoSCT as data is clear in terms of difference in the outcome in favor of patients achieving CMR vs. those who achieved < CMR. So I would do what it takes to...
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Answer from: Radiation Oncologist at Community Practice
In relapsed or refractory HL, if there is a single site or low volume active disease after salvage chemotherapy, I strongly recommend pre-transplant RT to that site prior to auto-SCT. As mentioned above, the best outcomes for auto-SCT are in patients who go in with CMR to salvage therapy prior to tr...
Answer from: Medical Oncologist at Community Practice
If this patient has refractory disease (had no response or even progression, not less than PR), I would try an alternative therapy. I would avoid chemotherapy, as the chances of an encouraging response and transplant, are very low and any long term response low. There are so many alternative t...