Treatment of refractory Hodgkin’s lymphoma: a puzzle to merge

About 80% of patients with Hodgkin’s lymphoma are like to be cured by first line chemotherapy. However some patients fail to reach remission or relapse early (within 3 months) after first-line therapy. These non-responders generally have a much worse prognosis and need to be identified as early as possible to lower their risk of treatment failure, avoid unnecessary toxicity and increase the chance of long term survival. High dose chemotherapy with autologous transplantation (HDCT) is considered the gold standard, while 40-50% of patients will have a recurrence. Several clinical variables present at the time of disease relapse or immediately prior to HDCT have been evaluated with regard to their influence on risk of recurrence following autologous transplant such as clinical stage, number of involved regions, B symptoms, extranodal disease, bulky disease, relapse in prior radiation field, duration of first remission less than 12 months and higher risk score as described by Hasenclever and Diehl at relapse.