Treatment of Relapsing/Refractory Hodgkin's Disease

Relapses of Hodgkin's disease (HD) occur in 10-15% of patients with a local tumor and in 20-40% of patients with advanced stages. A relapse of HD is early in half of the patients whereas a second remission can be achieved in only 50% of cases. Autologous hematopoietic stem cell transplantation (auto-SCT) is considered to be the standard of consolidation therapy for relapsing and primary-resistant HD. In patients with relapses of HD, progression-free survival and overall survival are 50% to 60% and 50% to 80%, respectively.

Objective. To assess the efficacy of different second-line therapies with subsequent autologous stem cell transplantation in the treatment of relapsing or refractory HD.

Materials and methods: from 2000 to 2017, 76 patients with relapsing/refractory HD treated with at least first-line therapy were involved in the study with most of the patients (70%) having received various modifications of BEACOPP regimen. The median age of patients was 27 years. A majority of participants had advanced stages of the disease: 23 (30%), 14 (18%), and 35 (46%) of patients have stage I-II, III, and IV, respectively.

Results: DHAP-regimen was given as a second-line treatment in 34 patients resulting in progression, an absence of effect, and overall response in 11 (32%), 13 (38%), and 9 of the patients, respectively. Of them, a complete remission was achieved in only 4 patients, who further underwent autologous stem cell transplantation as a consolidation treatment.

Dexa Beam regimen was given as a second-line treatment in 53 patients including those with progression after DHAP-courses. As a result, partial/complete remission, progression, and stable disease were achieved in 35 (66%), 7, and 11 patients, respectively.

Auto-SCT was carried out in 32 patients of the overall response group; 28 (88%), 3, and 4 patients have a complete long-term remission, progressive disease, and early relapses, respectively.

In the general study population, overall and event-free survival rates were respectively 86% and 71% with a follow-up median of 83 months.

Thus, Dexa Beam given as an induction treatment before auto-SCT showed an advantage in the overall response in relapsing/refractory HD. Implementation of auto-SCT as consolidation treatment after complete/partial remission has been achieved allows a long-term positive response to be attained.