Abstract
Introduction : Classic Hodgkin lymphoma (cHL) has become one of the most curable malignancies. However, there is still a significant number of patients who will be primary refractory or relapse (r/r). As example for localized cHL (i.e. stage I and II) the estimated probability of r/r disease is around 10-20% and for advanced stages (i.e. IIIB and IV) 20-40%, dependent on prognostic factors (Josting et al., J Clin Oncol, 2002. 20(1): p. 221-30 ). For young patients with relapse after autologous stem cell transplantation and those not eligible for myeloablative therapy new novel agents such brentuximab vedotin (BV) and nivolumab have been recently approved. Worldwide the experience with BV is increasing. Herein, we are reporting on our experience with BV in patients with r/r cHL. Outcome and side effects were analyzed.
Patients and methods: We retrospectively reviewed the records of patients with r/r cHL who received BV between 2014 to 2017 at our institution. Two independent reviewers collected the information and matched the collected data. Kaplan-Meier method was used to calculate overall survival and progression free survival (SPSS program was used).
Results: Total of 18 patients (10 female 8 males) fulfilled the inclusion criteria. Most patients had nodular sclerosis subtype (56%). At initiation of BV, 3 patients had stage II, 5 stage III, 11 stage IV, 13/18 had B symptoms and 8/18 extranodal disease. 11/18 patients have failed autologous stem cell transplantation, one patient failed allogeneic transplantation and 12/18 were refractory to previous line. Medians of previous lines and completed BV cycles were 3 (range 1-7) and 6 (range 1-17) respectively. After 4 cycles and by end of treatment the complete, partial, stable and progressive disease rates were 6%, 56%, 11%, 28% and 22%, 39%, 6% and 33% respectively. 7/18 went for autologous and one patients for allogeneic stem cell transplantation after reaching of satisfactory response with BV. 57% of the patients who went for stem cell transplantation remained disease free by last follow-up. Progression free and overall survival were 9 (CI 95%, 5.3-12.7) (table 1a) and 38 months (CI 95%, 20.7-55.2)(table 1b) respectively.
With regard to the safety profile, 6/18 patients developed grade 1-2 polyneuropathy who recovered after end of treatment and one patient grade neutropenia. No dose modification was required. In the follow-up period no second malignancy was documented.
Conclusion: In our cohort the response rate was 61% which is lower than reported in pivotal study (75%, Younes et al. J Clin Oncol. 2012 Jun 20;30(18):2183-2189) but similar to the results published by our group in the largest Meta-analysis (62,7%, Dada et al. Expert Opin Biol Ther. 2016 Jun;16(6):739-45). BV enables patients with cHL to reach responses qualifying them for stem cell transplantation and induces interesting response rates in patients who relapsed after stem cell transplantation.
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Disclosures
No relevant conflicts of interest to declare.
Pembrolizumab monotherapy in patients with primary refractory classical hodgkin lymphoma who relapsed after salvage autologous stem cell transplantation and/or brentuximab vedotin therapy: KEYNOTE-087 subgroup analysis
