Brentuximab vedotin is able to improve progression-free survival (PFS) in patients with relapsed/refractory (R/R) classical HL (cHL) and a high risk of relapse post-ASCT, and following its regulatory approval in the R/R cHL consolidation setting, a new generation of targeted therapies are being developed for use in this high-risk population. This led to initiation of clinical studies in the 1990s to improve post-ASCT outcomes and consequently improve HL cure rates, many of which showed less than satisfactory results, until the introduction of post-ASCT consolidation with brentuximab vedotin, an anti-cluster of differentiation 30 (CD30) antibody-drug conjugate (ADC). Despite this intensified approach, up to 50% of patients will experience progressive disease following ASCT, representing a population with high-risk disease. For patients who either relapse or are refractory to frontline treatment, the standard of care comprises salvage chemotherapy followed by autologous stem cell transplantation (ASCT). The currently available chemotherapies and targeted therapies deliver frontline cure rates of approximately 90% for patients with early- or intermediate-stage disease and 70–90% for patients with advanced-stage disease. Hodgkin lymphoma (HL) is considered to be a curable hematological malignancy. Future approvals of targeted agents are expected to further improve outcomes and provide additional treatment options in the coming age of personalized medicine. We conclude that early intervention with post-ASCT consolidation improves outcomes in patients with R/R HL who require ASCT. In this article, we provide a European perspective on the available treatment options and likely future developments in the salvage and consolidation settings, with the aim to improve management of patients with HL who have a high risk of post-ASCT failure. However, adoption of these new approaches has been inconsistent across different centers and regions. These include use of pre- and post-ASCT salvage therapies and post-ASCT consolidative therapy, with the greatest benefits demonstrated by targeted therapies, such as brentuximab vedotin. Over recent years, a number of different strategies have been assessed to improve post-ASCT outcomes and augment HL cure rates. However, a considerable number of patients who receive ASCT will progress/relapse and display suboptimal post-transplant outcomes. Autologous stem cell transplantation (ASCT) is a well-established approach to treatment of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) recommended by both the European Society for Medical Oncology and the National Comprehensive Cancer Network based on the results from randomized controlled studies.
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