Summary of treatment recommendations for autologous HCT for Hodgkin lymphoma
| Recommendation . | |
|---|---|
| Autologous HCT should be offered as first-line therapy for patients who fail to achieve CR. | |
| Autologous HCT should be offered as salvage therapy over nontransplantation (except for localized disease, in which IFRT may be considered, or for patients with low-stage disease and late relapse, in which chemotherapy may be considered). | |
| Several salvage chemotherapy regimens may be considered prior to autologous HCT in adult patients. | |
| BEAM or CBV are the most common conditioning regimens for autologous HCT in standard-risk patients. | |
| IFRT should be considered in patients with bulky disease not previously irradiated. | |
| Tandem autologous HCT is not routinely recommended in standard-risk patients. | |
| Maintenance therapy with brentuximab vedotin post autologous HCT is recommended in high-risk patients.a Additional maintenance therapies incorporating CPI are under investigation. | |
| Chemosensitive disease and negative functional imaging are associated with improved outcomes. | |
| Recent data with novel agents + chemotherapy +/− radiation in the second line suggests that in a highly selected population, some patients may not need to proceed with autologous HCT if they achieve a complete response. | |
| Recommendation . | |
|---|---|
| Autologous HCT should be offered as first-line therapy for patients who fail to achieve CR. | |
| Autologous HCT should be offered as salvage therapy over nontransplantation (except for localized disease, in which IFRT may be considered, or for patients with low-stage disease and late relapse, in which chemotherapy may be considered). | |
| Several salvage chemotherapy regimens may be considered prior to autologous HCT in adult patients. | |
| BEAM or CBV are the most common conditioning regimens for autologous HCT in standard-risk patients. | |
| IFRT should be considered in patients with bulky disease not previously irradiated. | |
| Tandem autologous HCT is not routinely recommended in standard-risk patients. | |
| Maintenance therapy with brentuximab vedotin post autologous HCT is recommended in high-risk patients.a Additional maintenance therapies incorporating CPI are under investigation. | |
| Chemosensitive disease and negative functional imaging are associated with improved outcomes. | |
| Recent data with novel agents + chemotherapy +/− radiation in the second line suggests that in a highly selected population, some patients may not need to proceed with autologous HCT if they achieve a complete response. | |
High-risk patients were defined in the AETHERA trial as having 1 of the following: refractory to frontline therapy, relapse less than 12 months after frontline therapy, or relapse 12 months or more after frontline therapy with extranodal disease.
BEAM, BCNU, etoposide, cytarabine, melphalan; CBV, cyclophosphamide, carmustine (BCNU), etoposide; GVD, gemcitabine, vinorelbine, and liposomal doxorubicin.
Adapted with permission from Perales et al.9