Sequencing therapies in Hodgkin lymphoma

Classical Hodgkin lymphoma is a highly curable malignancy, but challenges persist for how best to treat patients who are refractory to or relapse after first-line therapy. Multiagent induction chemotherapy followed by high-dose therapy with autologous haematopoietic stem-cell transplantation (HSCT) has been considered the standard of care for second-line treatment of Hodgkin lymphoma since the early 1990s. Since then, practice has evolved with the introduction of 18-fluorodeoxglucose PET imaging for response assessment, with autologous HSCT largely reserved for patients who have a complete metabolic response, or at least good partial response, to reinduction chemotherapy. However, there has otherwise been little change in therapeutic approaches to second-line treatment over the past few decades, despite the emergence of several effective targeted agents.