OBJECTIVES: Although most patients with Hodgkin lymphoma (HL) are successfully treated with first-line therapy, patients who fail can require multiple costly, additional treatments. Presently there is little information on how recurrent HL is managed in routine clinical practice, particularly, the progression to new lines of therapy among patients with relapsed/refractory HL (RRHL). We identified treatment patterns for an incident cohort of patients with HL in the USA. METHODS: We conducted a retrospective observational study of adults with HL from 2006–2015 using Truven MarketScan databases. Patients were required to be initially treated with a first-line therapy to be eligible. Therapies were classified based on records of prescriptions and chemotherapy administration. The frequency of individual therapies, and time to initiation of a subsequent therapy, were estimated according to line of therapy. RESULTS: The cohort included 4,304 treated incident patients: 55% male, mean age at diagnosis of 42.5 years. Twenty-three percent progressed to second-line therapy, of whom 34% proceeded to a third-line, and 56% of those treated in third line progressed to fourth-line therapy. Of all 4,304 first-line patients, 1.1% (n=48) eventually received a fourth line of therapy. The most common second-line therapies were autologous stem cell transplantation (ASCT; observed in 56% of the cohort), rituximab (18%), and ICE (ifosfamide, carboplatin, etoposide; 13%); third-line therapies were brentuximab vedotin (20%) and rituximab (11%); and fourth-line therapy was bendamustine (15%). The mean time between initiation of first- and second-line therapy was 96.3 weeks; time between lines decreased for subsequent lines of therapy. CONCLUSIONS: Patients with HL who fail first-line therapy are treated with a variety of strategies. In addition to ASCT and brentuximab vedotin, rituximab, bendamustine, and ICE were the most frequently used. These data characterize contemporary treatment patterns, and the variability in these confirm the individualized nature of care for RRHL patients.