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Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin’s lymphoma with an emphasis on targeted therapies and transplantation strategies

Authors Karantanos T, Politikos I, Boussiotis VA

Received 2 February 2017

Accepted for publication 11 April 2017

Published 9 May 2017 Volume 2017:7 Pages 37—52

DOI https://doi.org/10.2147/BLCTT.S105458

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor David Dingli


Theodoros Karantanos,1 Ioannis Politikos,2 Vassiliki A Boussiotis3–5

1General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Boston, MA, 2Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 3Division of Hematology-Oncology, 4Department of Medicine, Beth Israel Deaconess Medical Center, 5Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA, USA

Abstract: Hodgkin’s lymphoma (HL) is highly curable with first-line therapy. However, a minority of patients present with refractory disease or experience relapse after completion of frontline treatment. These patients are treated with salvage chemotherapy followed by autologous stem cell transplantation (ASCT), which remains the standard of care with curative potential for refractory or relapsed HL. Nevertheless, a significant percentage of such patients will progress after ASCT, and allogeneic hematopoietic stem cell transplantation remains the only curative approach in that setting. Recent advances in the pathophysiology of refractory or relapsed HL have provided the rationale for the development of novel targeted therapies with potent anti-HL activity and favorable toxicity profile, in contrast to cytotoxic chemotherapy. Brentuximab vedotin and programmed cell death-1-based immunotherapy have proven efficacy in the management of refractory or relapsed HL, whereas several other agents have shown promise in early clinical trials. Several of these agents are being incorporated with transplantation strategies in order to improve the outcomes of refractory or relapsed HL. In this review we summarize the current knowledge regarding the mechanisms responsible for the development of refractory/relapsed HL and the outcomes with current treatment strategies, with an emphasis on targeted therapies and hematopoietic stem cell transplantation.

Keywords:
relapsed/refractory Hodgkin’s lymphoma, pathophysiology, novel agents, immunotherapy, hematopoietic stem cell transplantation

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