The role of hematopoietic stem cell transplantation in advanced Hodgkin Lymphoma

Primary therapy of Hodgkin Lymphoma is generally successful. However, for the relatively small numbers of patients with relapsed or primary progressive disease, outcomes are not optimal. It is now recognized that high dose chemotherapy and autoSCT may be curative in a proportion of these patients. Nevertheless, survival even following autoSCT remains unsatisfactory, with relapse remaining the major concern. In particular, patients with primary progressive disease, those who fail to respond to salvage therapy, and those who are ineligible for autoSCT carry a relatively poor prognosis. In these groups of patients, clinical trials are examining tandem autologous stem cell transplantation or reduced intensity allogeneic transplantation. The latter procedure is promising in terms of its relatively low toxicities and its possibility of inciting a Graft-versus-Hodgkin Lymphoma effect. Further prospective clinical trials are required to clarify the role of allogeneic transplantation in poor risk Hodgkin Lymphoma.