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Relapsed Hodgkin Lymphoma: Management Strategies

  • Lymphomas (G Nowakowski, Section Editor)
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Abstract

Although Hodgkin lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50 % of these patients will be effectively salvaged with conventional therapies. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant. In this review, we summarize the most recent updates on the management of patients with relapsed HL, the role of novel therapies such as brentuximab vedotin, and an overview of promising new agents currently under investigation. We also discuss the role of consolidation strategies such as high-dose chemotherapy and autologous stem cell transplant, and reduced-intensity allogeneic hematopoietic stem cell transplant, and the need for new strategies in the elderly patient population.

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References

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  1. Available at: http://seer.cancer.gov/statfacts/html/hodg.html. Accessed May 11th, 2014.

  2. Evens AM, Hutchings M, Diehl V. Treatment of Hodgkin lymphoma: the past, present, and future. Nat Clin Pract Oncol. 2008;5:543–56.

    Article  PubMed  CAS  Google Scholar 

  3. Steidl C, Diepstra A, Lee T, et al. Gene expression profiling of microdissected Hodgkin Reed-Sternberg cells correlates with treatment outcome in classical Hodgkin lymphoma. Blood. 2012;120:3530–40.

    Article  PubMed  CAS  Google Scholar 

  4. Scott DW, Chan FC, Hong F, et al. Gene expression-based model using formalin-fixed paraffin-embedded biopsies predicts overall survival in advanced-stage classical Hodgkin lymphoma. J Clin Oncol. 2013;31:692–700.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. 1998;339:1506–14.

    Article  PubMed  CAS  Google Scholar 

  6. Gallamini A, Rigacci L, Merli F, et al. The predictive value of positron emission tomography scanning performed after two courses of standard therapy on treatment outcome in advanced stage Hodgkin's disease. Haematologica. 2006;91:475–81.

    PubMed  Google Scholar 

  7. Gallamini A, Hutchings M, Rigacci L, et al. Early interim 2-[18 F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin Oncol. 2007;25:3746–52.

    Article  PubMed  CAS  Google Scholar 

  8. Diefenbach CS LH, Hong F. Evaluation Of a Novel 3 Factor Prognostic Score (PS-3) For Patients With Advanced Hodgkin Lymphoma (HL) Treated On US Intergroup E2496. Blood. 2013;122(21):4277.

    Google Scholar 

  9. Viviani S, Santoro A, Negretti E, et al. Salvage chemotherapy in Hodgkin's disease. Results in patients relapsing more than twelve months after first complete remission. Ann Oncol. 1990;1:123–7.

    PubMed  CAS  Google Scholar 

  10. Brice P, Bastion Y, Divine M, et al. Analysis of prognostic factors after the first relapse of Hodgkin's disease in 187 patients. Cancer. 1996;78:1293–9.

    Article  PubMed  CAS  Google Scholar 

  11. Smeltzer JP, Cashen AF, Zhang Q, et al. Prognostic significance of FDG-PET in relapsed or refractory classical Hodgkin lymphoma treated with standard salvage chemotherapy and autologous stem cell transplantation. Biol Blood Marrow Transplant. 2011;17:1646–52.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Moskowitz AJ, Yahalom J, Kewalramani T, et al. Pretransplantation functional imaging predicts outcome following autologous stem cell transplantation for relapsed and refractory Hodgkin lymphoma. Blood. 2010;116:4934–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Jabbour E, Hosing C, Ayers G, et al. Pretransplant positive positron emission tomography/gallium scans predict poor outcome in patients with recurrent/refractory Hodgkin lymphoma. Cancer. 2007;109:2481–9.

    Article  PubMed  Google Scholar 

  14. Devillier R, Coso D, Castagna L, et al. Positron emission tomography response at the time of autologous stem cell transplantation predicts outcome of patients with relapsed and/or refractory Hodgkin's lymphoma responding to prior salvage therapy. Haematologica. 2012;97:1073–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Castagna L, Bramanti S, Balzarotti M, et al. Predictive value of early 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) during salvage chemotherapy in relapsing/refractory Hodgkin lymphoma (HL) treated with high-dose chemotherapy. Br J Haematol. 2009;145:369–72.

    Article  PubMed  CAS  Google Scholar 

  16. Moskowitz CH, Matasar MJ, Zelenetz AD, et al. Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. Blood. 2012;119:1665–70. The prospective study that provides evidence that the goal of salvage chemotherapy in patients with HL should be a negative FDG-PET scan before ASCT.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Martinez C, Canals C, Sarina B, et al. Identification of prognostic factors predicting outcome in Hodgkin's lymphoma patients relapsing after autologous stem cell transplantation. Ann Oncol. 2013;24:2430–4. Largest study so far conducted to assess the predictors of outcome of patients with Hodgkin lymphoma relapsing after autologous stem cell transplant.

    Article  PubMed  CAS  Google Scholar 

  18. Linch DC, Winfield D, Goldstone AH, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993;341:1051–4.

    Article  PubMed  CAS  Google Scholar 

  19. Schmitz N, Pfistner B, Sextro M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. 2002;359:2065–71.

    Article  PubMed  CAS  Google Scholar 

  20. Moskowitz C. Risk-adapted therapy for relapsed and refractory lymphoma using ICE chemotherapy. Cancer Chemother Pharmacol. 2002;49(Supp 1):S9–12.

    Article  PubMed  CAS  Google Scholar 

  21. Moskowitz CH, Nimer SD, Zelenetz AD, et al. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model. Blood. 2001;97:616–23.

    Article  PubMed  CAS  Google Scholar 

  22. Josting A, Rudolph C, Reiser M, et al. Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease. Ann Oncol. 2002;13:1628–35.

    Article  PubMed  CAS  Google Scholar 

  23. Baetz T, Belch A, Couban S, et al. Gemcitabine, dexamethasone and cisplatin is an active and non-toxic chemotherapy regimen in relapsed or refractory Hodgkin's disease: a phase II study by the National Cancer Institute of Canada Clinical Trials Group. Ann Oncol. 2003;14:1762–7.

    Article  PubMed  CAS  Google Scholar 

  24. Bartlett NL, Niedzwiecki D, Johnson JL, et al. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin's lymphoma: CALGB 59804. Ann Oncol. 2007;18:1071–9.

    Article  PubMed  CAS  Google Scholar 

  25. Ng M, Waters J, Cunningham D, et al. Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma. Br J Cancer. 2005;92:1352–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Hawkes EA, Barton S, Cunningham D, et al. GEM-P chemotherapy is active in the treatment of relapsed Hodgkin lymphoma. Ann Hematol. 2014;93:827–34. Single institution study showing impressive ORR of 80% and 37% of CR with salvage outpatient chemotherapy regimen gemcitabine based, non cross toxic with first line chemotherapy drugs.

    Article  PubMed  CAS  Google Scholar 

  27. Brandwein JM, Callum J, Sutcliffe SB, et al. Evaluation of cytoreductive therapy prior to high dose treatment with autologous bone marrow transplantation in relapsed and refractory Hodgkin's disease. Bone Marrow Transplant. 1990;5:99–103.

    PubMed  CAS  Google Scholar 

  28. Colwill R, Crump M, Couture F, et al. Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease before intensive therapy and autologous bone marrow transplantation. J Clin Oncol. 1995;13:396–402.

    PubMed  CAS  Google Scholar 

  29. Falini B, Pileri S, Pizzolo G, et al. CD30 (Ki-1) molecule: a new cytokine receptor of the tumor necrosis factor receptor superfamily as a tool for diagnosis and immunotherapy. Blood. 1995;85:1–14.

    PubMed  CAS  Google Scholar 

  30. Bartlett NL, Younes A, Carabasi MH, et al. A phase 1 multidose study of SGN-30 immunotherapy in patients with refractory or recurrent CD30+ hematologic malignancies. Blood. 2008;111:1848–54.

    Article  PubMed  CAS  Google Scholar 

  31. Forero-Torres A, Leonard JP, Younes A, et al. A Phase II study of SGN-30 (anti-CD30 mAb) in Hodgkin lymphoma or systemic anaplastic large cell lymphoma. Br J Haematol. 2009;146:171–9.

    Article  PubMed  CAS  Google Scholar 

  32. Fanale MA, Forero-Torres A, Rosenblatt JD, et al. A phase I weekly dosing study of brentuximab vedotin in patients with relapsed/refractory CD30-positive hematologic malignancies. Clin Cancer Res. 2012;18:248–55. The phase I trial that showed favorable safety profile and significant activity of Brentuximab in patient with relapsed/refractory CD30 positive lymphomas.

    Article  PubMed  CAS  Google Scholar 

  33. Younes A, Bartlett NL, Leonard JP, et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. 2010;363:1812–21.

    Article  PubMed  CAS  Google Scholar 

  34. Younes A, Gopal AK, Smith SE, Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30:2183. The phase II trial that led to the accelerated FDA approval of Brentuximab in relapsed or refractory Hodgkin lymphoma.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Rothe A, Sasse S, Goergen H, et al. Brentuximab vedotin for relapsed or refractory CD30+ hematologic malignancies: the German Hodgkin Study Group experience. Blood. 2012;120:1470–2.

    Article  PubMed  CAS  Google Scholar 

  36. Sasse S, Rothe A, Goergen H, et al. Brentuximab vedotin (SGN-35) in patients with transplant-naive relapsed/refractory Hodgkin lymphoma. Leuk Lymphoma. 2013;54:2144–8.

    Article  PubMed  CAS  Google Scholar 

  37. Chen R FS, Palmer j et al Two-year follow up of patients with relapsed/refractory Hodgkin treated with brentuximab vedotin prior to reduced intensity allogeneic hematopoietic cell transplantation. Presented at the 12th International Conference on Malignant Lymphoma, Lugano, Switzerland, June 19-22, 2013, 2013

  38. Garciaz S, Coso D, Peyrade F, et al: Brentuximab vedotin followed by allogeneic transplantation as salvage regimen in patients with relapsed and/or refractory Hodgkin's lymphoma. Hematol Oncol, 2013 Brentuximab as a bridge to allogeneic transplant in patients with refractory disease.

  39. Chen RW PJ, Siddiqi T, et al. : Brentuximab vedotin as first line salvage therapy in relapsed/refractory HL. ASH Annual Meeting Abstracts. 2012;120(21):3699, 2012

  40. Moskowitz AJ SH, Gerecitano J, et al: PET-adapted sequential therapy with brentuximab vedotin and augmented-ICE induces FDG-PET normalization in 92% of patients with relapsed and refractory Hodgkin lymphoma, Presented at the 12th International Conference on Malignant Lymphoma, Lugano, Switzerland, June 19–22, 2013.

  41. Bartlett NL, Chen R, Fanale MA, et al. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014;7:24. First study assessing efficacy and toxicity of brentuximab in the setting of retreatment.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gopal AK, Ramchandren R, O'Connor OA, et al. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012;120:560–8. First study assessing the safety and efficacy of brentuximab in the setting of relapse post allogeneic stem transplant.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Ozegowski W. KD: w-[bis-(chlorethyl)-amino-benzimidazolyl-(2)]-propionic or butyric acids as potential cytostatic agents. J Prakt Chem. 1963;20:178–86.

    Article  CAS  Google Scholar 

  44. Ruffert KJH, Syrbe G, et al. Cytostasan (bendamustine) as an alternative therapeutic approach to treat malignant non-Hodgkin’s lymphoma. Z Klin Med. 1989;44:671–4.

    Google Scholar 

  45. Brockmann B. Therapy of the recurrence of malignant lymphoma. Z Aerztl Fortbild (Jena). 1992;86:843.

    CAS  Google Scholar 

  46. Herold M. KK, Anger G, et al: Risk-adapted combined radiotherapy and chemotherapy for Hodgkin’s disease – results of a pilot study. Onkologie. 1992;15:501–5.

    Article  Google Scholar 

  47. Moskowitz AJ, Hamlin Jr PA, Perales MA, et al. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol. 2013;31:456–60. First prospective phase II trial evaluating efficacy of bendamustine in heavily pretreated Hodgkin lymphoma patients.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  48. Ghesquieres H, Stamatoullas A, Casasnovas O, et al. Clinical experience of bendamustine in relapsed or refractory Hodgkin lymphoma: a retrospective analysis of the French compassionate use program in 28 patients. Leuk Lymphoma. 2013;54:2399–404. Recent retrospective study confirming acitvity of bendamustine in heavily pretreated patients with HL.

    Article  PubMed  CAS  Google Scholar 

  49. Corazzelli G, Angrilli F, D'Arco A, et al. Efficacy and safety of bendamustine for the treatment of patients with recurring Hodgkin lymphoma. Br J Haematol. 2013;160:207–15. Recent retrospective study confirming acitvity of bendamustine in heavily pretreated patients with HL.

    Article  PubMed  CAS  Google Scholar 

  50. Dutton A, Reynolds GM, Dawson CW, et al. Constitutive activation of phosphatidyl-inositide 3 kinase contributes to the survival of Hodgkin's lymphoma cells through a mechanism involving Akt kinase and mTOR. J Pathol. 2005;205:498–506.

    Article  PubMed  CAS  Google Scholar 

  51. Johnston PB, Inwards DJ, Colgan JP, et al. A Phase II trial of the oral mTOR inhibitor everolimus in relapsed Hodgkin lymphoma. Am J Hematol. 2010;85:320–4.

    PubMed  CAS  Google Scholar 

  52. Oki Y, Buglio D, Fanale M, et al. Phase I study of panobinostat plus everolimus in patients with relapsed or refractory lymphoma. Clin Cancer Res. 2013;19:6882–90. Phase I study suggesting synergy of the combination of HDACI panobinostat with mTOR inhibitor everolimus, although limited by the development of significative thrombocytopenia in more than half of the patients.

    Article  PubMed  CAS  Google Scholar 

  53. Buglio D, Georgakis GV, Hanabuchi S, et al. Vorinostat inhibits STAT6-mediated TH2 cytokine and TARC production and induces cell death in Hodgkin lymphoma cell lines. Blood. 2008;112:1424–33.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  54. Younes A, Sureda A, Ben-Yehuda D, et al. Panobinostat in patients with relapsed/refractory Hodgkin's lymphoma after autologous stem-cell transplantation: results of a phase II study. J Clin Oncol. 2012;30:2197–203. The largest phase II trial conducted with the panobinostat, which demonstrated to be the most effective HDACI in Hodgkin lymphoma.

    Article  PubMed  CAS  Google Scholar 

  55. Younes A, Oki Y, Bociek RG, et al. Mocetinostat for relapsed classical Hodgkin's lymphoma: an open-label, single-arm, phase 2 trial. Lancet Oncol. 2011;12:1222–8.

    Article  PubMed  CAS  Google Scholar 

  56. Kirschbaum MH, Goldman BH, Zain JM, et al. A phase 2 study of vorinostat for treatment of relapsed or refractory Hodgkin lymphoma: Southwest Oncology Group Study S0517. Leuk Lymphoma. 2012;53:259–62.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  57. Harrison SJ, Hsu AK, Neeson P, et al. Early thymus and activation-regulated chemokine (TARC) reduction and response following panobinostat treatment in patients with relapsed/refractory Hodgkin lymphoma following autologous stem cell transplant. Leuk Lymphoma. 2014;55:1053–60.

    Article  PubMed  CAS  Google Scholar 

  58. Fehniger TA, Larson S, Trinkaus K, et al. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood. 2011;118:5119–25. The largest phase II trial of lenalidomide in Hodgkin lymphoma.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  59. Sawas AC-GS, Neylon E. A Case Series Of Continuous Low Dose Lenalidomide In Patients With Relapsed Or Refractory Classical Hodgkin Lymphoma. Blood. 2013;122:5134.

    Google Scholar 

  60. Kuruvilla JTD, Wang L. Phase II Trial of Lenalidomide in Patients with Relapsed or Refractory Hodgkin Lymphoma. Blood. 2008;112:3052. ASH Annual Meeting Abstracts.

    Article  Google Scholar 

  61. Younes A, Romaguera J, Hagemeister F, et al. A pilot study of rituximab in patients with recurrent, classic Hodgkin disease. Cancer. 2003;98:310–4.

    Article  PubMed  CAS  Google Scholar 

  62. Oki Y, Pro B, Fayad LE, et al. Phase 2 study of gemcitabine in combination with rituximab in patients with recurrent or refractory Hodgkin lymphoma. Cancer. 2008;112:831–6.

    Article  PubMed  CAS  Google Scholar 

  63. Hahn T, McCarthy Jr PL, Hassebroek A, et al. Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors. J Clin Oncol. 2013;31:2437–49.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Anderlini P, Saliba R, Acholonu S, et al. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience. Haematologica. 2008;93:257–64.

    Article  PubMed  CAS  Google Scholar 

  65. Sureda A, Robinson S, Canals C, et al. Reduced-intensity conditioning compared with conventional allogeneic stem-cell transplantation in relapsed or refractory Hodgkin's lymphoma: an analysis from the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol. 2008;26:455–62.

    Article  PubMed  CAS  Google Scholar 

  66. Sureda A, Canals C, Arranz R, et al. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study - a prospective clinical trial by the Grupo Espanol de Linfomas/Trasplante de Medula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2012;97:310–7. The largest prospective trial so far on the role of RIC allo-sct in Hodgkin lymphoma.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Sobol U, Rodriguez T, Smith S, et al: Seven-year follow-up of allogeneic transplant using BCNU, etoposide, cytarabine and melphalan chemotherapy in patients with Hodgkin lymphoma after autograft failure: importance of minimal residual disease. Leuk Lymphoma, 2013.

  68. Anderlini P SR, Ledesma C: Reduced-Intensity Conditioning (RIC) and Allogeneic Stem Cell Transplantation (allo-SCT) For Relapsed/Refractory Hodgkin Lymphoma (HL) In The Brentuximab Vedotin Era: Favorable Overall and Progression-Free Survival (OS/PFS) With Low Transplant-Related Mortality (TRM) Blood 2013 122:410, 2013.

  69. Proctor SJ, Wilkinson J, Jones G, et al. Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study. Blood. 2012;119:6005–15.

    Article  PubMed  CAS  Google Scholar 

  70. Evens AM, Helenowski I, Ramsdale E, et al. A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era. Blood. 2012;119:692–5.

    Article  PubMed  CAS  Google Scholar 

  71. Kelley TW, Pohlman B, Elson P, et al. The ratio of FOXP3+ regulatory T cells to granzyme B + cytotoxic T/NK cells predicts prognosis in classical Hodgkin lymphoma and is independent of bcl-2 and MAL expression. Am J Clin Pathol. 2007;128:958–65.

    Article  PubMed  Google Scholar 

  72. Halbsguth TV, Boll B, Borchmann P, et al. The unique characteristics and management of patients over 60 years of age with classic Hodgkin lymphoma. Curr Hematol Malig Rep. 2011;6:164–71.

    Article  PubMed  Google Scholar 

  73. Boll B, Goergen H, Arndt N, et al. Relapsed hodgkin lymphoma in older patients: a comprehensive analysis from the German hodgkin study group. J Clin Oncol. 2013;31:4431–7. Largest retrospective study on safety and efficacy of second line treatment modalities in older patients with relapsed or refractory Hodgkin Lymphoma.

    Article  PubMed  Google Scholar 

  74. Puig N, Pintilie M, Seshadri T, et al. High-dose chemotherapy and auto-SCT in elderly patients with Hodgkin's lymphoma. Bone Marrow Transplant. 2011;46:1339–44.

    Article  PubMed  CAS  Google Scholar 

  75. Gopal AK, Bartlett NL, Forero-Torres A, et al: Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma, 2014 Largest retrospective analysis evaluating the safety and efficacy of brentuximab in older patients (60 years and older) with relapsed or refractory Hodgkin lymphoma or Anaplastic Large Cell lymphoma.

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Acknowledgments

CD is supported by a Clinical Investigator Career Development Award from the Lymphoma Research Foundation.

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Dr. Francesca Montanari declares no potential conflicts of interest.

Dr. Catherine Diefenbach is a consultant for Seattle Genetics.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Montanari, F., Diefenbach, C. Relapsed Hodgkin Lymphoma: Management Strategies. Curr Hematol Malig Rep 9, 284–293 (2014). https://doi.org/10.1007/s11899-014-0220-7

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