Hematopoietic stem cell transplantation in Hodgkin disease.

Intensive therapy and autologous stem cell transplantation represent the standard of care in most patients whose Hodgkin disease has not been cured with conventional chemotherapy. With more prolonged follow-up of autografted patients, the problems with autologous stem cell transplantation are clear. In particular, recurrent disease and late transplant-related complications limit the effectiveness of this approach. A number of autologous stem cell transplantation studies have reported prognostic factors that will help identify patients at high risk for relapse. Several new approaches for decreasing recurrence rates are discussed, including novel immune strategies and re-evaluation of allogeneic stem cell transplantation. Although the risk of secondary malignancy and other causes of late morbidity and mortality after autologous stem cell transplantation is relatively low, current studies contribute to understanding of the pathogenesis of these complications and may diminish their impact in the future.