Despite a high clinical success, relapse in Hodgkin lymphoma occurs in 10–30% of cases and 5–10% patients are nonresponsive to initial chemotherapy. The standard management of these patients includes high-dose chemotherapy followed by autologous stem cell transplant. However, 50% of patients ultimately relapse after autotransplant which poses a big challenge. Allogeneic stem cell transplantation offers the only chance of cure in these patients. For patients who are not candidates for allogeneic stem cell transplantation, achieving cure with other possible options is highly unlikely, and thus the treatment plan becomes noncurative. Various novel agents have shown promising results but the duration of response is short lived. A standard approach to deliver the most effective treatment for these patients is still lacking. This review focuses on the treatment options currently available for relapsed and refractory disease after autotransplant. 1. Introduction Hodgkin lymphoma (HL) is a potentially curable lymphoma with distinct histology, biologic behaviour, and clinical characteristics. The reported five-year event-free survival ranges between 80 and 90% with combined modality chemotherapy and radiotherapy [1]. Despite the high cure rate with initial therapy, approximately 5% to 10% of patients have refractory disease, and 10% to 30% patients relapse after an initial complete response [2]. Autologous stem cell transplantation (ASCT) is the standard of care for patients with relapsed HL [3]. About half of all patients undergoing ASCT are rescued and definitely cured by such an approach, but the outcome of patients relapsing or refractory to second-line chemotherapy and ASCT is dismal, with a median survival of less than three years [4]. One of the most important and widely accepted prognostic factors for patients undergoing ASCT appears to be chemosensitivity at relapse, with patients responding to second-line chemotherapy and having a much better outcome than patients with refractory disease, whose relapse rate approaches 80% in some published series [5, 6]. In the functional imaging with positron emission tomography (PET) era, PET positive response at the end of induction therapy has been found to be the worst predictor of outcome [7, 8]. There are a few published literatures on the treatment options of patients with RR-HL after autotransplant. This paper summarizes the current available treatment modalities in these patients with emphasis on novel drugs. 2. Diagnosis of RR-HL A diagnostic rebiopsy should be considered to confirm relapse or progressive
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