Hodgkin Lymphoma: Relapsed/Refractory

The term “relapsed” refers to disease that reappears or grows again after a period of remission.

The term “refractory” is used to describe when the lymphoma does not respond to treatment (meaning that the cancer cells continue to grow) or when the response to treatment does not last very long.

For classical HL, most relapses typically occur within the first three years following diagnosis, although some relapses occur much later. For patients who relapse or become refractory, secondary therapies are often successful in providing another remission and may even cure the disease.

A number of treatment options are available for patients with relapsed or refractory HL. The type of treatment prescribed for individual patients depends on several factors, including the timing of the relapse, age and overall health of the patient, scope of disease, and previous therapies received.

The current standard secondary treatment for the majority of patients consists of combination therapy, usually followed by autologous stem cell transplantation (in which a patient’s own stem cells are used). Involved site radiation therapy (ISRT) may also be used.

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Transplantation

Hodgkin lymphoma patients who fail to achieve complete remission following frontline therapy or who relapse after achieving complete remission are often treated with second-line chemotherapy regimens, followed by a bone marrow or stem cell transplant. A transplant of bone marrow or stem cells is needed to restore healthy bone marrow. To learn more about stem cell transplantation, download the Understanding the Stem Cell Transplantation Process booklet.

There are a variety of single-agent and combination therapy regimens that may be used for relapsed/refractory HL, including:

• Brentuximab vedotin (Adcetris)
• Bendamustine (Treanda)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)
• DHAP (dexamethasone, cisplatin, and cytarabine)
• ESHAP (etoposide, methylprednisolone, cisplatin, and cytarabine)
• GVD (gemcitabine, vinorelbine, and liposomal doxorubicin)
• ICE (ifosfamide, carboplatin, and etoposide)
• IGEV (ifosfamide, gemcitabine, and vinorelbine)

Treatments Under Investigation

Although the cure rate in HL is already high, research continues to look for ways to treat the minority of patients who are refractory to treatment and those who relapse. Many promising therapies are currently under investigation in clinical trials for HL including:

• Anti-CD30-CAR T cells
• Atezolizumab (Tecentriq)
• Bortezomib (Velcade)
• Carfilzomib (Kyprolis)
• Everolimus (Afinitor)
• Ibrutinib (Imbruvica)
• Lenalidomide (Revlimid)
• Mocetinostat (MGCD0103)
• Ruxolitinib (Jakafi)
• Umbralisib

To learn about treatments under investigation for HL, download the Hodgkin Lymphoma Booklet or Relapsed/ Refractory Hodgkin Lymphoma Fact Sheet.