The optimal time for autologous hematopoietic progenitor cell transplantation during treatment of Hodgkin's lymphoma. Foreign recommendations and russian experience

Autologous hematopoietic stem cell transplantation (HSCT) is the standard treatment for patients with relapsed and primary refractory Hodgkin's lymphoma (HL). According to current recommendations HSCT must be performed in first relapse or after registration of primary resistance disease. However, the HSCT in optimal time for all patients with HL who need it is impossible, due to insufficient capacity of national transplant centers. Analysis of the HSCT results from 369 HL patients treated in Russia and other CIS countries clinics showed that intensive long-term standard chemotherapy prior to transplantation is a poor prognostic factor regarding to mobilization efficacy, hematopoiesis recovery and late HSCT results. In this regard, to achieve best results HSCT must be performed no later than the second relapse or immediately after registration of primary resistance disease. Treatment results in patients received a lot of chemotherapy before transplantation is worse. But they still have a chance for a cure and should be considered as potential candidates to HSCT if obtained sufficient graft quality and hematopoietic response to induction chemotherapy is achieved.