Would you recommend ISRT after salvage auto transplant for relapsed classical Hodgkin Lymphoma if the patient had Deauville 2 after ICEx2 prior to BEAM auto transplant and now has Deauville 1 imaging?

There are no randomized studies (to my knowledge) formally evaluating the role of consolidation RT in the setting of relapsed Hodgkin lymphoma (HL) and autologous stem cell transplantation (ASCT). Outcomes are universally worse in the salvage setting compared with upfront management. Therefore, it seems prudent to optimally leverage RT (the most effective single modality in HL) in this scenario under appropriate circumstances. In my mind, these include:

1. Localized relapse - Regardless of the extent of initial disease, if a patient relapses with localized disease, then I would recommend consolidation RT to all involved sites. I would give 30 Gy if in CR (Deauville 1-3) assuming no RT was used initially. As always, we would use appropriate ...