Review Article
Refractory and Relapsed Hodgkin Lymphoma:
A Comprehensive Review of Biology and Recent Advances in Therapy
Adil Abdelhamed Abbas*
Issue:
Volume 11, Issue 4, December 2026
Pages:
84-98
Received:
4 August 2026
Accepted:
5 September 2026
Published:
15 October 2026
DOI:
10.11648/j.ijcocr.20261104.11
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Views:
Abstract: HL accounts for nearly 3% of pediatric cancers. Compared to NLPHL, cHL primarily affects older children and adolescents. The risk-adapted, response-based management approach, which uses combined modality therapy, advances in modern imaging techniques, and careful use of consolidation RT, has led to steady improvements in EFS and OS, with current rates surpassing 90%. However, nearly 10–30% of patients may still experience resistant disease or relapse at different times. Achieving a second CR is generally difficult. Conventional CTR, HD CTR, and ABMT have been the main treatments for several decades. Advanced-stage (stage III and IV) R&R HL generally requires intensive treatment. Meanwhile, treatment for low-stage relapses (stage I and II) require a less intensive approach. The popularity of purely conventional CTR agents is decreasing. Combining one or more of the newer targeted medications, such as brentuximab vedotin, with conventional CTR, or utilizing pure targeted medications to induce second remission, has become standard practice. The treatment outcomes for R&R HL decline with each subsequent relapse. Second and third relapses usually result in much worse outcomes. Depending on the pattern and timing of relapse, the EFS after second-line treatment ranges from 10% to 50%. Many newly identified genetic mutations and molecular pathways are linked to the disease development and progression. Targeting these pathways may help cure patients who do not respond to current therapies. Allogeneic BMT may offer some assistance. The recently developed anti-CD30, CAR T-cell therapy shows promise, especially for patients with refractory disease and those experiencing frequent relapses. In this review, we discuss the mechanisms behind the disease's resistance to treatment and modern approaches to overcoming it.
Abstract: HL accounts for nearly 3% of pediatric cancers. Compared to NLPHL, cHL primarily affects older children and adolescents. The risk-adapted, response-based management approach, which uses combined modality therapy, advances in modern imaging techniques, and careful use of consolidation RT, has led to steady improvements in EFS and OS, with current ra...
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