Therapy for Relapsed and Refractory Pediatric Hodgkin Lymphoma

The treatment of Hodgkin lymphoma (HL) has improved dramatically over the past two decades. The reported five-year event free survival ranges between 80 – 90% with combined modality chemotherapy and radiotherapy. However, 10 15% of patients with localized disease and 25% of patients with advanced classical Hodgkin Lymphoma (cHL) have recurrent disease after first line treatment. (Lohri, Barnett et al. 1991; Longo, Duffey et al. 1992; Ferme, Mounier et al. 2002). Refractory patients are also problematic occurring in 2 5% of patient with low stage (I/II) and 5 – 10% of high stage (III/IV) cHL (Diehl, Franklin et al. 2003). Retrieval of patients with relapsed and refractory Hodgkin Lymphoma (RR-HL) can be achieved with the use of salvage chemotherapy that includes front-line chemotherapy agents and high dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) (Andre, Henry-Amar et al. 1999; Lazarus, Rowlings et al. 1999). This chapter will discuss the various second line therapeutic approaches for retrieval of patients with RR-HL.