The place of high-dose therapy with haemopoietic stem cell transplantation in relapsed and refractory Hodgkin's disease.

Conventional salvage therapy in Hodgkin's disease is appropriate in patients who relapse after a first complete remission of greater than one year many of whom who will have good long term survival with no further therapy. Patients who do not achieve CR, who relapse within one year of CR1 or who have a second relapse will have a survival of less than 20% at 5 years and these patients are candidates for high dose therapy (HDT) and Autologous Bone Marrow Transplantation (ABMT) or a second line salvage protocol. Current published and registry data suggests that HDT and ABMT may be superior and there is data from one prospective randomized trial to support this view. The best practice of ABMT to be used in this context must be decided after consideration of; timing, status, source of haematological stem cells, use of haematopoietic growth factors (HGF's) and dose and scheduling of high dose therapy. Confirmatory randomised trials are still urgently required before the optimal strategy for the management of relapsed Hodgkin's disease is defined.