Primary refractory Hodgkin's disease

Primary refractory Hodgkin's disease may generally be defined as progression of disease during induction treatment or a partial or transient response (< 60 days) to induction therapy. Salvage chemotherapy is inadequate in this patient population; fewer than 10% of patients survive for 10 years or longer. Improved outcomes after failure of primary induction therapy have been reported with myeloablative therapy and autografting. The projected event-free survivals ranged from 18%-49% at four years. Highly selected patients may benefit from salvage radiotherapy, but this may be best accomplished in combination with transplantation. A number of strategies might be considered for increasing the cure rate for the small subset of patients with primary refractory Hodgkin's disease. Among these, identification of patients at high risk for induction failure and modifications of primary treatment to address this risk hold the greatest promise for success.