High dose therapy for Hodgkin's disease

High dose therapy with haemopoietic stem cell support is now the standard a pproach to patients failing conventional dose chemotherapy for Hodgkin's de sease (HD) although there is a lack of data from randomized trials substant iating this practise. There is even less data to justify transplanting pati ents in first complete remission although this might be appropriate for a s mall minority of patients. Approximately 40% of patients receiving high dos e salvage therapy have achieved prolonged progression free survival with sl ightly better results in some centres. Of those who relapse after high dose therapy a significant proportion will have a further good, albeit usually transient, response to conventional dose therapy which contrasts markedly w ith the situation in non-Hodgkin's lymphoma. As the results of front-line t herapy for HD improve, there will be selection of the very worst prognosis patients for high dose therapy, and there will be an increasing need to dev elop improved salvage strategies.