High-dose chemotherapy followed by autologous stem cell transplant (ASCT) is the standard therapy for patients with relapsed or refractory Hodgkin lymphoma. Several analyses have reported risk factors for a poor outcome after ASCT to allow for an individualized treatment, but there is no consensus on how the outcome in high-risk patients might be improved. A recent study by Cocorocchio et al. analyzes risk factors in 97 patients who received ASCT. Besides the established risk factor remission status after induction, result of positron emission tomography before and after transplant was the most important prognostic factor for progression-free survival and overall survival. This result is in line with other retrospective analyses and might allow for the selection of high-risk patients who should receive alternative treatment approaches, such as second-line salvage therapy, tandem ASCT, new drugs or maintenance therapy. Randomized trials characterizing the best therapeutic option for high-risk patients are highly warranted.