Abstract
Simple SummaryThe standard treatment for Hodgkin lymphoma (HL) patients presenting a relapsed/refractory (R/R) disease is salvage chemotherapy followed by autologous stem cell transplantation (ASCT). With commonly used chemotherapy combinations, 25–30% fail to proceed to ASCT, with poor outcomes. The aim of this retrospective study was to evaluate the efficacy of brentuximab vedotin (BV) and pembrolizumab combination as a bridge to ASCT in R/R HL patients. We retrospectively collected data from 10 patients, 8 male and 2 female, with a median age of 30.7 years. The median follow-up time was 16.5 months, while the median number of received cycles of treatment was 4 (2–7). Eight patients proceeded to ASCT (80%) and seven of them to subsequent BV maintenance, with two early disease progression (PD). The BV and pembrolizumab combination is a very effective bridge treatment to ASCT for high-risk R/R HL patients. Classical Hodgkin lymphoma (HL) patients presenting a relapsed/refractory (R/R) disease are currently managed with salvage chemotherapy followed by autologous stem cell transplantation (ASCT). However, almost 25–30% of these patients fail to achieve a complete response (CR) with standard salvage regimens. In this retrospective study, we evaluated the efficacy of a combination of brentuximab vedotin (BV) and pembrolizumab in a series of HL patients presenting with a high-risk, multi-refractory disease. Patients achieving a Deauville score ≤4 proceeded to ASCT consolidation. After ASCT, patients received BV as maintenance for a total of 16 administrations. We collected data from 10 patients with a median age of 30.7 years. At a median follow-up of 16.5 months, we reported a complete metabolic remission (CMR) in eight patients (80%), with seven patients (70%) directly proceeding to ASCT (the other two patients in CMR are still undergoing treatment). BV consolidation was started in six patients and completed by three patients (one ongoing, two interruption). Two patients (20%) presented a progressive disease (PD) and subsequently died, while the others are still in CMR. The BV and pembrolizumab combination is a very effective bridge treatment to ASCT for high-risk R/R HL patients.
Highlights
Classical Hodgkin lymphoma (HL) is nowadays a highly curable disease, with standard first line polychemotherapy regimens achieving a complete remission (CR) rate of80–90%
The standard approach in this setting is salvage treatment followed by autologous stem cell transplantation (ASCT); almost half of the patients who undergo ASCT
Nine (90%) patients presented an advanced disease at relapse, six (60%) a primary refractory disease, six (60%) extranodal disease at relapse and four (40%) a CR duration less than 12 months
Summary
Classical Hodgkin lymphoma (HL) is nowadays a highly curable disease, with standard first line polychemotherapy regimens achieving a complete remission (CR) rate of80–90%. 20–30% of patients will experience a relapse or a progressive disease (PD) [1,2,3]. The standard approach in this setting is salvage treatment followed by autologous stem cell transplantation (ASCT); almost half of the patients who undergo ASCT present long term disease remissions [4,5]. Several salvage chemotherapy schemes have been tested in this setting and mostly described in retrospective series; a gold standard treatment has not yet been identified. With commonly used chemotherapy combinations, 25–30% of these patients fail to achieve a complete metabolic response (CMR), which seems to be the most important prognostic factor to achieve a prolonged progressionfree survival (PFS) and to proceed to ASCT, with subsequently poor outcomes [6,7].
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