American Society of Transplantation and Cellular Therapy Clinical Practice Recommendations for Transplantation in Classical Hodgkin Lymphoma

Autologous hematopoietic cell transplantation (auto-HCT) remains the standard therapeutic approach for patients with chemotherapy-sensitive relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL). Over the past decade, the therapeutic landscape for cHL has evolved substantially with the introduction of novel agents, including antibody-drug conjugates and immune checkpoint inhibitors, which have demonstrated significant efficacy in the relapsed setting and are now incorporated into frontline treatment regimens. These advances have not only expanded the armamentarium available for disease management but have also led to improved long-term outcomes, raising important considerations regarding the optimal sequencing of therapies and the evolving role of transplantation in the modern treatment paradigm. HCT remains a cornerstone in the management of cHL; however, consensus is lacking regarding the optimal timing of auto-HCT, the sequencing and integration of novel therapeutic agents, the potential role of maintenance therapy following auto-HCT, and the appropriate indications and timing for allogeneic (allo) HCT. Therefore, the American Society of Transplantation and Cellular Therapy Committee on Practice Guidelines undertook a project to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 20 consensus statements with key recommendations as follows: (1) use of auto-HCT consolidation after salvage therapy in the first relapse setting, for patients with chemotherapy-sensitive R/R cHL in complete response; (2) preferred use of pre-HCT salvage therapy regimens with novel agents; (3) consultation for allo-HCT in eligible patients who have disease relapse after auto-HCT; (4) guidance regarding optimal stem cell donor source; (5) selection of conditioning regimen for both auto-HCT and allo-HCT; and (6) preferred graft versus host disease prophylaxis in the modern era. These clinical practice recommendations serve as a tool to guide clinical management of R/R cHL.