Long-term follow-up of 2 patients treated with 90
Y-rituximab radioimmunotherapy for relapse of nodular lymphocyte-predominant Hodgkin lymphoma

Abstract The HD9 trial of the German Hodgkin Study Group (GHSG) compared two different doses (baseline and escalated) of the novel chemotherapy regimen BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in patients with advanced-stage Hodgkin lymphoma (HL). The previous analysis with a median follow-up of 5 years showed improved tumor control (FFTF) and overall survival (OS) for BEACOPPescalated. Since BEACOPPescalated had been associated with more toxicity as compared with ABVD we report the results of long-term follow-up of 1196 patients enrolled and randomized in that study. The median follow-up was 112 months; a total of 370 centres contributed. Patients received one of three chemotherapy regimens: 8 cycles of COPP (cyclophosphamide, vincristine, procarbazine, and prednisone) alternating with ABVD (doxorubicin, bleomycin, vinblastin, and dacarbazine), 8 cycles of standard-dose BEACOPP or 8 cycles of escalated-dose BEACOPP. At 10 years, FFTF rates were 64%, 70% and 82%, OS rates were 75%, 80%, and 86 for COPP-ABVD (arm A), BEACOPPbaseline (arm B), and BEACOPPescalated, respectively (p < 0,001). Importantly, BEACOPPescalated was also significantly better than BEACOPPbaseline in terms of FFTF (p < 0.0001) and OS (p = 0.0053). Death due to HL occurred in 11.5%, 8.1% and 2.8% in arms A, B, and C, respectively. 74 second malignancies were documented, including secondary acute myeloid leukaemias (1,7,14), Non-Hodgkin lymphoma (7,8,5), and solid tumors (7,16,9) in arms A, B, and C respectively. The corresponding overall secondary malignancy rates were 6.7%, 8.9% and 6.8%. Importantly, the risk of secondary AML (sAML), although increased in this study after BEACOPPescalated, amounts to 0.9% in our follow-up study with BEACOPPescalated (HD12) in 1502 advanced-stage HL patients randomized and four years median follow-up. Although the higher rate of secondary AML after BEACOPPescalated in HD9 most likely occurred by chance, interestingly, 70% of patients in this group had additional radiotherapy whereas only 39% were radiated in HD12. Taken together, the 10 years follow-up of BEACOPPescalated chemotherapy demonstrates a stabilized significant improvement in long-term FFTF and OS for advanced-stage HL. Although for formal prove the results of ongoing prospective randomized comparisons with 8 cycles of ABVD might be required, these results clearly challenge ABVD as standard of care for this patient population.

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A Long-Term Follow-up Report on Autologous Hematopoetic Cell Transplant (AuHCT) for Patients with Hodgkin Lymphoma — Limited Utility of Post-Transplant Surveillance Computerized Axial Tomography (CAT scan) and/or PET Scan,

Blood ◽

10.1182/blood.v118.21.4205.4205 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4205-4205

Author(s):

Henry C. Fung ◽

Sunita Nathan ◽

Neel B. Shah ◽

John J. Maciejewski ◽

Elizabeth Shima Rich ◽

...

Keyword(s):

Disease Progression ◽

Hodgkin Lymphoma ◽

Pet Scan ◽

Late Relapse ◽

Cell Transplant ◽

Post Transplant ◽

Cat Scan ◽

Long Term Follow Up

Abstract Abstract 4205 Background: Autologous Hematopoetic Cell Transplant (AuHCT) is the treatment of choice for patients with relapsed or refractory Hodgkin Lymphoma. Approximately 40–60% of patients achieve a durable response and possible cure after the transplant with progressive disease accounts for most of the treatment failures. CAT scan +/− PET scan are usually performed before AuHCT and repeated post-transplant to assess responses. As part of the long term follow-up; post-transplant surveillance CAT scan +/− PET scan are often performed with intent to detect early disease progression and possible early intervention. Here, we attempt to evaluate the utility of this approach by examining the patterns of treatment failures for patients with Hodgkin Lymphoma who received AuHCT. Patients/Methods: A retrospective chart review was performed. Between 01/94 and 12/06, 55 consecutive patients with refractory or relapsed Hodgkin Lymphoma underwent autologous HCT at our institution. All patients underwent a CAT scan and FDG-PET before AuHCT and approximately 2–3 months following the transplant to evaluate the response to HCT. As part of the long-term follow-up; post-transplant surveillance CAT scan were performed every 3–6 months for 2–3 years, then every 6–12 months up to 5 years post-transplant. Results: A total of 55 patients were followed post autologous HCT. The median age at HCT was 32 (ranging from 15–66); 27 were male. Seventeen patients had primary progressive HL and 38 had relapsed HL. Eighteen patients had extra-nodal disease at disease progression. With a minimal follow-up of 4 years (range 4 to 7 years) for living patients; 40 patients are alive and well with no evidence of disease. Thirteen patients developed disease progression after transplant at a median of 3 months (range 0 – 32 months) post-HCT. All the disease progression developed within the first 7 months after transplant except 2 who developed late relapse 28 and 32 months post-HCT. Fifteen patients died with 10 from progressive disease and 5 from non-relapse causes: auto accident: 1, breast cancer (incident diagnosed of late recurrent Hodgkin lymphoma): 1, AML:1 and 2 from chronic graft versus host disease after salvage allogeneic HCT. All 55 patients underwent PET scan evaluation 2–3 months after HCT to evaluate post-HCT responses. Twenty-nine patients had no evidence of PET activity post transplant, while 26 patients had evidence of activity. While there were 2 subsequent progressions in the PET negative group (1 of them was a late relapse), there were 9 progressions in the PET positive group. The 5-years estimated survival was 65%. Conclusion: In summary: 1) Most of the disease progressions after AuHCT for relapsed and refractory Hodgkin Lymphoma occurred within the first seven months after the transplant and were associated with abnormal first post-transplant CT +/− PET scan. Thus, the utility of long term surveillance radiological studies is very limited and is not recommended. 2) With longer follow-up, long-term complications including second cancer replace disease as the primary cause of treatment failure. This underscores the importance of long-term follow-up for HCT long-term survivors. Disclosures: No relevant conflicts of interest to declare.

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