Hematology/Oncology Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

July 09, 2018

In This Article

Refractory Hodgkin Lymphoma

National Comprehensive Cancer Network

NCCN recommendations for relapsed or refractory classic HL

Histologic confirmation with biopsy is recommended before initiating treatment for refractory disease.

Second-line systemic therapy is recommended for all patients with refractory disease, followed by response assessment with PET.

Patients with a Deauville score of 1 to 3 should then be treated with HDT/ASCR (high-dose chemotherapy followed by autologous stem cell rescue or transplant) with or without RT, followed by observation or 1 year of brentuximab vedotin (BV) maintenance therapy for patients with a high risk of relapse as defined by the AETHERA trial.

RT should be strongly considered for selected sites of relapse that have not been previously irradiated.

If HDT/ASCR is contraindicated, observation with or without RT is recommended.

For patients with a Deauville score of 4 or 5 after second-line systemic therapy, subsequent systemic therapy (±RT) or RT alone is recommended, followed by repeat response assessment. Alternatively, those with a Deauville score of 4 can be treated with HDT/ASCR with or without RT, followed by observation or 1 year of BV maintenance therapy for patients with a high risk of relapse.

If patients with a Deauville score of 5 are responsive to secondary therapy, autologous or allogeneic stem cell transplantation is an option.

Reference

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