High dose therapy for Hodgkinʹs disease

High dose therapy with haemopoietic stem cell support is now the standard approach to patients failing conventional dose chemotherapy for Hodgkinʹs desease (HD) although there is a lack of data from randomized trials substantiating this practise. There is even less data to justify transplanting patients in first complete remission although this might be appropriate for a small minority of patients. Approximately 40% of patients receiving high dose salvage therapy have achieved prolonged progression free survival with slightly better results in some centres. Of those who relapse after high dose therapy, a significant proportion will have a further good, albeit usually transient, response to conventional dose therapy which contrasts markedly with the situation in non-Hodgkinʹs lymphoma. As the results of front-line therapy for HD improve, there will be selection of the very worst prognosis patients for high dose therapy, and there will be an increasing need to develop improved salvage strategies.