Novel Salvage Therapy Options for Initial Treatment of Relapsed/Refractory Classical Hodgkin's Lymphoma: So Many Options, How to Choose?

Simple Summary Relapsed/refractory classical Hodgkin's lymphoma (cHL) accounts for 10-30% of patients. Historically, such patients were treated with salvage chemotherapy regimens followed by autologous stem cell transplantation. Introduction of novel agents such as brentuximab vedotin and immunotherapy to the treatment algorithm for cHL may change the choice of salvage therapy regimens. The purpose of this article is to review the various salvage regimens used to treat first relapse or primary refractory disease that incorporate novel agents, discuss the recent literature and propose an algorithm to determine the treatment approach for this patient population. The treatment landscape for relapsed/refractory classical Hodgkin's lymphoma (cHL) has evolved with the introduction of several novel agents. Historically, the standard of care for relapsed cHL was salvage chemotherapy followed by autologous stem cell transplant (ASCT). However, many patients are ineligible for ASCT or will have poor responses to salvage chemotherapy and ASCT. Brentuximab vedotin (BV) and checkpoint inhibitors (nivolumab/pembrolizumab) were initially approved in the post-ASCT setting. However, as a result of excellent responses and durable outcomes in this setting, they are now being studied and explored in earlier lines of therapy. Additionally, these agents are also being studied for post-transplant consolidation and maintenance with promising results in improving progression-free survival. We will review current salvage therapy options involving these novel agents and provide comparisons between regimens to aid the clinician in selecting the appropriate salvage regimen for patients who progress after first-line therapy.