Current Management of Relapsed or Refractory Classic Hodgkin Lymphoma in Canada

Résumé

Classic Hodgkin lymphoma (HL) is a rare B-cell malignancy with approximately 1,150 new cases diagnosed annually in Canada. Outcomes have improved substantially over the past several decades, with HL-related mortality declining by 2.2–3.0% annually since 1984, reflecting advances in both first-line and salvage therapies. Despite this progress, 10–30% of patients develop primary refractory or relapsed (R/R) disease, with risk influenced by stage, treatment regimen, and clinical features. Relapse rates are further decreasing with contemporary first-line regimens such as nivolumab, doxorubicin, vinblastine, and dacarbazine (nivolumab-AVD) and brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD), and are now estimated at 5–10% in advanced-stage disease. Key adverse prognostic factors at relapse include primary refractory disease, relapse within 12 months, and advanced-stage disease.

The introduction of novel targeted therapies, including the anti-CD30 antibody-drug conjugate brentuximab vedotin (BV) and the programmed death-1 (PD-1) inhibitors nivolumab and pembrolizumab, has led to improved outcomes in R/R HL. However, in Canada, access to targeted therapies has been constrained by delays in funding and restrictive approval criteria. In this review, we address common challenges and outline our approach to the treatment of adults with R/R HL within the contemporary Canadian context.