Craig Moskowitz and Daniel Persky

The majority of patients with Hodgkin's lymphoma (HL) are cured with radiation therapy (RT) and/or combination chemotherapy. However, patients who relapse or those with primary refractory disease have a poor outcome with conventional-dose salvage regimens. Treatment results with these salvage regimens produce a low complete remission rate and minimal survival benefit. Long-term survival is poor when either MOPP or MOPP/ABVD is administered with curative intent in the salvage setting.12 Over the past two decades, results of many prospective clinical trials utilizing high-dose chemotherapy or chemoradiother-apy (HDT) with autologous stem cell transplantation (ASCT) in the salvage setting are reported, and approximately 40% of patients appear to be cured using this approach.3

Most early transplant studies included heavily pre-treated patients receiving autologous bone marrow as the stem cell source, both of which influenced the morbidity and mortality of HDT.4-6 With the introduction of granulocyte colony-stimulating factor (G-CSF), peripheral blood progenitor cells, better transfusion practices, more effective antibiotics, and the omission of patients with disease progression pre-ASCT, the transplant-related mortality has decreased from 15% to less than 3% in most series. Despite these strides in supportive care, long-term freedom from treatment failure (FFTF) for the patients receiving HDT/ASCT has improved by less than 10% in recent series. There are a number of pretreatment and treatment-related prognostic factors that predict for outcome.7

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