{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:19:52Z","timestamp":1780654792201,"version":"3.54.1"},"reference-count":39,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,12,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Approximately 10% to 30% of patients with classical Hodgkin lymphoma (cHL) develop relapsed or refractory (R\/R) disease. Of those patients, 50% to 60% show long-term progression-free survival after standard salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). In the past decade, novel therapies have been developed, such as the CD30-directed antibody\u2013drug conjugate brentuximab vedotin and immune checkpoint inhibitors, which have greatly extended the treatment possibilities for patients with R\/R cHL. Several phase 1\/2 clinical trials have shown promising results of these new drugs as monotherapy or in combination with chemotherapy, but unfortunately, very few randomized phase 3 trials have been performed in this setting, making it difficult to give evidence-based recommendations for optimal treatment sequencing. Two important goals for the improvement in the treatment of R\/R cHL can be identified: (1) increasing long-term progression-free and overall survival by optimizing risk-adapted treatment and (2) decreasing toxicity in patients with a low risk of relapse of disease by evaluating the need for HDCT\/ASCT in these patients. In this review, we discuss treatment options for patients with R\/R cHL in different settings: patients with a first relapse, primary refractory disease, and in patients who are ineligible or unfit for ASCT. Results of clinical trials investigating novel therapies or strategies published over the past 5 years are summarized.<\/jats:p>","DOI":"10.1182\/hematology.2021000311","type":"journal-article","created":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T12:10:50Z","timestamp":1639138250000},"page":"240-246","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":12,"title":["How to choose first salvage therapy in Hodgkin lymphoma: traditional chemotherapy vs novel agents"],"prefix":"10.1182","volume":"2021","author":[{"given":"Julia","family":"Driessen","sequence":"first","affiliation":[{"name":"Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne H.","family":"Tonino","sequence":"additional","affiliation":[{"name":"Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison J.","family":"Moskowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Jos\u00e9","family":"Kersten","sequence":"additional","affiliation":[{"name":"Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2021,12,10]]},"reference":[{"issue":"8","key":"2021121012064616700_hem2021000311C1","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.3109\/10428194.2013.854888","article-title":"Outcome and risk factors of patients with Hodgkin lymphoma who relapse or progress after autologous stem cell 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