Skip to content
Triangle logo TriangleGet started
← Hodgkin Lymphoma

HEALTH PROFESSIONAL · SOURCE READING

Chemotherapy with stem cell transplant

Source: Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: February 12, 2025 · Captured 2026-09-09.

Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.

Context: Treatment of Recurrent Classic HL / Treatment Options for Recurrent Classic HL

Patients whose HL relapses after initial combination chemotherapy can undergo reinduction with the same or another chemotherapy regimen followed by high-dose chemotherapy and autologous bone marrow or peripheral stem cell or allogeneic bone marrow rescue.[1,28-31] This therapy has resulted in 3- to 4-year DFS rates of up to 50%. Patients who are responsive to reinduction therapy may have a better prognosis after subsequent autologous SCT; in one analysis, the 3-year event-free survival (EFS) rate was 80% with negative PET-CT scan results and 29% with positive PET-CT scan results.[32]

Source links and citations

Patients who do not respond to induction chemotherapy (about 20%‒25% of all presenting patients) have survival rates lower than 10% at 8 years.[3] For these patients, high-dose chemotherapy and autologous bone marrow or peripheral stem cell or allogeneic bone marrow rescue [28,29,33-35] have resulted in 5-year DFS rates of around 25% to 30%, but selection bias clearly influences these numbers.[28,29,34,36,37]

Source links and citations

In a retrospective review of 105 patients, those older than 60 years fared better with a combination of chemotherapy and salvage radiation therapy than with the use of intensified transplant consolidation.[38][Level of evidence C3]

Source links and citations

The use of HLA-matched sibling marrow (allogeneic transplant) results in lower relapse rates, but the benefit may be offset by increased toxic effects.[28,39,40] Reduced-intensity conditioning for allogeneic SCT is also under clinical evaluation.[41-43]

Source links and citations

Evidence (chemotherapy with SCT):

A randomized trial compared aggressive conventional chemotherapy versus high-dose chemotherapy with autologous hematopoietic SCT for relapsed chemosensitive HL.[44][Level of evidence B1]

Source links and citations

A randomized trial compared aggressive conventional chemotherapy versus high-dose chemotherapy with autologous hematopoietic SCT for relapsed chemosensitive HL.[44][Level of evidence B1]

This trial showed improvement in freedom from treatment failure at 3 years for the transplant arm (55%) versus the chemotherapy-alone arm (34%).[44]

Source links and citations

A randomized trial compared aggressive conventional chemotherapy versus high-dose chemotherapy with autologous hematopoietic SCT for relapsed chemosensitive HL.[44][Level of evidence B1]

No difference was observed in overall survival (OS).

A Cochrane meta-analysis concluded that autologous SCT after reinduction chemotherapy improves relapse-free survival by 20% to 30% over chemotherapy alone, but without an OS benefit.[45][Level of evidence B1]

Source links and citations

In three retrospective reviews of patients who underwent autologous bone marrow transplant (BMT) for relapsed or refractory disease, a comparison was made between those who received involved-field radiation therapy (IFRT) for residual masses after high-dose therapy and those who received no further treatment.[46-48]

Source links and citations

In three retrospective reviews of patients who underwent autologous bone marrow transplant (BMT) for relapsed or refractory disease, a comparison was made between those who received involved-field radiation therapy (IFRT) for residual masses after high-dose therapy and those who received no further treatment.[46-48]

Those who received IFRT had decreased local disease recurrence.

In three retrospective reviews of patients who underwent autologous bone marrow transplant (BMT) for relapsed or refractory disease, a comparison was made between those who received involved-field radiation therapy (IFRT) for residual masses after high-dose therapy and those who received no further treatment.[46-48]

Normalization of fluorine F 18-fludeoxyglucose PET-CT scans after reinduction therapy predicted a much better outcome after SCT, with an EFS rate of 80% versus 29% in one phase II trial.[32][Level of evidence C2]

Source links and citations

After completion of autologous SCT for recurrent HL, 329 patients were randomly assigned to receive brentuximab vedotin or placebo in a double-blind trial (AETHERA [NCT01100502]).[22,23]

Source links and citations

With a median follow-up of 5.0 years, the 5-year PFS rate for brentuximab vedotin was 59% (95% CI, 51%–66%) versus 41% (95% CI, 33%–49%) for placebo (HR, 0.521; 95% CI, 0.379–0.717).[22,23][Level of evidence B1]

Source links and citations

The 16-month treatment duration after transplant was not achieved by most patients because they developed progressive peripheral neuropathy, which was partially reversible after discontinuation of brentuximab vedotin.

It is unclear whether the results of this trial are applicable when brentuximab vedotin is employed before transplant, such as during reinduction after relapse or during initial therapy (presently under clinical evaluation).

A phase II trial reported a response rate higher than 50% for patients with relapsing disease after autologous BMT.[49][Level of evidence C3] For patients with recurrent disease after autologous BMT, weekly vinblastine therapy has provided palliation with minimal toxic effects.[50][Level of evidence C3]

Source links and citations

Studies cited in this source section

Source citation is not a determination that a study applies to you.

Publication references

Read the original reference and check its publication notices.

Preserved source evidence · Not medical advice