6.4 Treatment
Treatment will depend on the location, extent of recurrent or residual disease, previous management and the patient’s preferences.
In managing people with Hodgkin lymphoma and DLBCL, treatment may include these options:
- conventional-dose salvage chemotherapy
- high-dose chemotherapy with autologous stem cell transplantation
- palliative chemotherapy
- allogeneic stem cell transplantation (see section 6.4.1)
- radiation therapy
- immunological or targeted therapies
- CAR-T therapy (chimeric antigen receptor therapy [engineered immune cells]).
Some of these treatments are not available at all treatment centres and referral to specialised centres may be appropriate.
The potential goals of treatment should be discussed, respecting the patient’s cultural values. Wherever possible, written information should be provided.
Encourage early referral to clinical trials or accepting an invitation to participate in research.
Combination chemotherapy regimens with autologous stem cell transplantation is considered in first relapse. In subsequent relapses or where autologous stem cell transplantation is not appropriate, clinical trials should be considered. Novel biologic agents may be indicated, in the case of Hodgkin lymphoma.
Currently, stem cell transplantation can only take place in tertiary public hospitals with appropriate expertise and facilities (Australian Government Medical Services Advisory Committee 2019).
Health service characteristics
To provide safe and quality care for patients having stem cell transplants, health services should have these features, in addition to the health services characteristics listed in section 4.2.1:
- dedicated standard isolation rooms (single rooms with ensuite and clinical handwashing facilities)
- access to a cell separator for collecting peripheral blood progenitor cells, with appropriately trained nursing staff available for the operation of cell separators.
