Background: The optimal treatment for paediatric relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL) is undefined. Standard salvage treatment is re-induction chemotherapy followed by consolidation with high dose chemotherapy (HDCT) / autologous stem cell transplantation (ASCT). However some patients may be salvaged with chemo-radiotherapy only thereby avoiding toxicity of transplant while in others the standard HDCT/ASCT would be predicted to fail and allogeneic transplant has been proposed as an alternative approach. Purpose: To evaluate outcomes of risk and response adapted salvage strategies in R/R cHL in our centre. Patients and Methods: A retrospective study between 2005-16 identified 23 first relapse patients; median age 14 (3-19) years; M:F ratio 1.6:1; median time to relapse 10 months (1 month - 180). First line treatment was multi-agent chemotherapy with (n=5) or without radiotherapy (n=18). Salvage was re-induction chemotherapy in all patients followed by consolidation treatment which was selected based on an assessment of prognostic factors and assessment of response to salvage chemotherapy. RT consolidation was used in 4 patients with later relapse who achieved a complete metabolic remission (CMR) with one line of salvage. HDCT/ASCT was used in 13 patients, all in a CMR after one (n=5), two (n=7) or four (n=1) lines of salvage. Allo-SCT was used in 6 patients, five in CMR [after one (n=1), two (n=2), three (n=1) or four (n=1)] lines of salvage. Results: 4/4 consolidated with RT only (no transplant) remain well in second remission, median follow-up 66 months. 11/13 consolidated with HDCT/ASCT (conditioning BEAM/LEAM) remain in second remission, median follow-up 18 months. Only 2/6 consolidated with allo-SCT (conditioning regimen BEAM-Campath in 5 and FMC in 1) remain in second remission, median follow up of 24 months while 2/6 relapsed and 2/6 died of early treatment toxicities. Conclusions: Only 4/23 patients experienced a second relapse. 0/4 in the RT group, 2/13 in the HDCT/ASCT group, 2/6 in the Allo-SCT group. Two patients died of infection / toxicity post allo-SCT. The disease free survival (DFS) by consolidation group was 100% in the RT group, 85% in the HDCT/ASCT group, and 33% in the allo-SCT group. A risk and response adapted salvage approach achieved excellent outcomes with RT or HDCT/ASCT consolidation but the outcomes with allogeneic transplant are less encouraging due to relapse and toxicity in this small study.