Hodgkin’s Lymphoma: An Environmental Scan
Table of Contents
3.12 When Gold-Standard Treatments Fail: Relapse/Refractory HL
Despite the fact that an overwhelming majority of individuals experience excellent treatment and survival outcomes after their initial primary treatment, there remains a group of patients who suffer from two other specific outcomes. One, the relapse of their HL, whereby, the lymphoma returns after a period of time (for cHL the average time is 3 years) or two, those individuals whose HL becomes refractory or they fail to achieve a complete remission with primary treatment . When either of these situations occurs, secondary or more aggressive therapies such as different forms of combination chemotherapies, also known as ‘salvage’ chemotherapy and stem cell or bone marrow transplants become further treatment options (Böll, Borchmann, and Diehl 2010).
Individuals who suffer a relapse have a 50% chance of a cure using second-line treatment. However, cure rates are affected by the length of time it takes for a relapse to occur. For those who experience a relapse within 12 months of their initial treatment, cure rates are lower. Those whose relapses occur later tend to have somewhat higher cure rates. The treatment options for patients whose disease has relapsed generally focuses on “salvage” chemotherapy regimens using different combination chemotherapy drugs and in higher doses. In some instances, after high-dose chemotherapy the patient may undergo autologous stem cell transplantation (ASCT) (Gianni et al. 1997). This involves the collection of the patient’s own stem cells (before they are destroyed by high-dose chemotherapy or radiation therapy treatments). These stem cells are then reintroduced into the patient’s body. High-dose chemotherapy with stem cell transplantation is generally a safe procedure, with less than a 1 to 2% risk of death related to the treatment (Torjman et al. 2007).