High-dose therapy with hematopoietic transplantation for Hodgkin's lymphoma

The use of combination chemotherapy has been successful in treating advanced or widespread Hodgkin's disease (HD). For patients with relapsed disease, the long-term prognosis is much poorer, despite the good rate of reinduction into a second or further remission using conventional treatments. The majority of such patients will ultimately relapse again if given only conventional salvage chemotherapy. The transplantation or reinfusion of hematopoetic stem cells allows the use of higher doses of cytotoxic drugs that would normally be precluded by myelotoxicity. Hematopoiesis rescue by autologous transplantation of stem cells has become an accepted form of treatment for HD that has failed to respond to first-line chemotherapy, which has relapsed within 1 year after chemotherapy, or which has relapsed on more than one occasion. Dose escalation with autologous stem cells is fashionable, but there is an increasing tendency to consider allogeneic transplantation in HD. There may be some limited graft-versus-Hodgkin's lymphoma effect, but this is outweighed by the greatly increased treatment toxicity associated with the allogeneic procedure. It is possible, however, that modern low-intensity conditioning regimens, the so-called mini-allograft approach, may increase the use of allogeneic transplantation for poor-prognosis Hodgkin's lymphoma patients in the future.