Primary refractory Hodgkin's disease

Primary refractory Hodgkin's disease may generally be defined as progressio n of disease during induction treatment or a partial or transient response (< 60 days) to induction therapy. Salvage chemotherapy is inadequate in thi s patient population: fewer than 10% of patients survive for 10 years or lo nger. Improved outcomes after failure of primary induction therapy have bee n reported with myeloablative therapy and autografting. The projected event -free survivals ranged from 18%-49% at four years. Highly selected patients may benefit from salvage radiotherapy, but this may be best accomplished i n combination with transplantation. A number of strategies might be conside red for increasing the cure rate for the small subset of patients with prim ary refractory Hodgkin's disease. Among these, identification of patients a t high risk for induction failure and modifications of primary, treatment t o address this risk hold the greatest promise for success.