Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor, updated 12/2018
Patients with relapsed or recurrent Hodgkin’s lymphoma are curable and can be further divided into two broad categories. Patients who fail to achieve an initial complete disappearance or remission of their cancer following a complete course of chemotherapy treatment are referred to as “induction failures.” Other patients achieve a complete remission to initial treatment and later experience a cancer recurrence. These patients are said to have relapsed or recurrent Hodgkin’s lymphoma. Relapse of cancer may occur several months to years after the initial remission; however, the majority of relapses occur within 2 years of initial treatment.
Treatment of Induction Failures
Patients who fail to achieve an initial complete remission or disappearance of their cancer following a complete course of chemotherapy treatment are referred to as “induction failures.” This is a broad group since it includes patients whose cancer actually grew or progressed during chemotherapy as well as those with an almost complete disappearance of cancer. Historically, all of these patients were treated with additional chemotherapy using drugs to which the patient had not been previously exposed and/or radiation therapy. Treatment of induction failures with several cycles of “salvage” chemotherapy produces a complete remission of cancer in 30%-40% of patients and up to ~20% of patients survive without an additional cancer relapse.
In the 1980’s high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) was discovered to cure 40%-50% of induction failures which was a marked improvement over traditional conventional chemotherapy.
In 1993 a clinical trial confirmed the benefit of HDC and ASCT, reporting in the medical journal Lancet that there HDC and ASCT resulted in a 53% chance of being alive without disease recurrence, compared to only 10% for patients treated with conventional chemotherapy. HDC and ASCT has become the standard initial salvage treatment for the majority of patients with Hodgkin’s lymphoma failing to achieve an initial remission. In order to learn more, select Stem Cell Transplantation. Over the last few decades hospital length of stays have been reduced to a few weeks and the risk associated with the HDC and ASCT and not that much different that those from standard chemotherapy.
Treatment of Relapsed Hodgkin’s Lymphoma
Historically, patients that relapse with Hodgkin’s lymphoma were treated with additional chemotherapy using drugs to which the patient had not been previously exposed and or radiation therapy. Treatment of relapsed patients with several cycles of “salvage” chemotherapy produces a complete disappearance or remission of cancer in 30%-40% of patients and as many as 25% survive without an additional cancer relapse.
In the 1980'2 a clinical trial was designed to directly compare HDC AND ASCT in order to confirm the benefit of HDC as salvage treatment for patients with relapsed Hodgkin’s lymphoma. The results of this clinical trial were published in 1993 in the journal Lancet and demonstrated that HDC and ASCT cured 5 times as many patients as conventional chemotherapy. High-dose chemotherapy has become the standard salvage treatment for the majority of patients with relapsed Hodgkin’s lymphoma. Some patients with relapsed Hodgkin’s disease may benefit from other types of transplants including allogeneic stem cell transplant, and most recently CAR-T cell therapy. These patients include those with refractory disease or large cancers or who have insufficient stem cells available for an ASCT.
Individuals with Hodgkin's lymphoma failing initial treatment should consider being evaluated at a cancer center or clinic with expertise in HDC and ASCT because these centers produce better outcomes and are dedicated to further improving the way HDC and SCT is utilized. In order to learn more, select stem cell transplantation.
Strategies to Improve Treatment
The progress that has been made in the treatment of relapsed Hodgkin’s lymphoma has resulted from the development of high-dose chemotherapy regimens, new treatment strategies and their evaluation in clinical trials. Currently, there are several areas of active exploration aimed at improving the treatment of Hodgkin’s lymphoma.
CAR T Cells: The use of a patient’s own immune cells to fight cancer through a technique called CART therapy, is proving to be a promising therapeutic approach in the treatment of some lymphomas. Learn about CAR T here:
New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials in patients with relapsed or recurrent lymphoma.
Stem Cell Transplant: New techniques and technologies designed to increase the effectiveness and decrease the side effects of stem cell transplant are being evaluated. To learn more, select Stem Cell Transplant.
Phase I Trials of Chemotherapy: New chemotherapy drugs continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and to determine whether the drug has any anti-cancer activity in patients with lymphoma. Phase I trials are usually performed in patients with recurrent or refractory cancer.