ASTCT updates transplant guidelines for relapsed Hodgkin lymphoma in the era of novel therapies

The treatment playbook for classical Hodgkin lymphoma (cHL) has changed dramatically — and now the guidelines are catching up. The American Society for Transplantation and Cellular Therapy (ASTCT) has published updated clinical practice recommendations for transplantation in relapsed or refractory cHL, addressing key questions around therapy sequencing, transplant timing, and maintenance strategies in an era increasingly defined by brentuximab vedotin and checkpoint inhibitors.

Despite the rise of these powerful novel agents, autologous hematopoietic cell transplantation (HCT) remains the recommended consolidative strategy for patients with chemotherapy-sensitive relapsed disease — backed by a Grade A recommendation with 95% panel consensus. The guidelines also stress the importance of early referral to transplant centers and timely consideration of allogeneic HCT for patients who relapse after autologous transplant and remain sensitive to therapy.

Key Takeaways:

• Novel salvage regimens incorporating brentuximab vedotin or checkpoint inhibitors are preferred over conventional chemotherapy alone before transplant
• Post-transplant maintenance generated the most debate — consensus was lower (79–84%) for patients previously exposed to novel agents, reflecting a real-world data gap
• Allogeneic HCT consultation is recommended for eligible patients exposed to both brentuximab vedotin and checkpoint inhibition with chemotherapy-sensitive disease
• Community oncologists are urged to refer patients to transplant centers early — ideally while planning salvage therapy, not after multiple failures

Why it matters: With novel therapies increasingly moving into frontline use, clinicians face new and complex decisions about when transplant is still needed. These guidelines offer a much-needed roadmap — though key questions, like whether some patients can skip transplant altogether, remain unanswered pending prospective trial data.