Abstract
This retrospective study aimed to describe the Hellenic experience on the use of brentuximab vedotin (BV) in relapsed/refractory (R/R) Hodgkin lymphoma (HL) given within its indication. From June 2011 to April 2015, ninety‐five patients with R/R HL, who received BV in 20 centers from Greece, were analyzed. Their median age was 33 years, and 62% were males. Sixty‐seven patients received BV after autologous stem cell transplantation failure, whereas 28 patients were treated with BV without a prior autologous stem cell transplantation, due to advanced age/comorbidities or chemorefractory disease. The median number of prior treatments was 4 and 44% of the patients were refractory to their most recent therapy. The median number of BV cycles was 8 (range, 2‐16), and the median time to best response was the fourth cycle. Fifty‐seven patients achieved an objective response: twenty‐two (23%), a complete response (CR), and 35 patients (37%), a partial, for an overall response rate of 60%. Twelve patients (13%) had stable disease, and the remaining twenty‐six (27%) had progressive disease as their best response. At a median follow‐up of 11.5 months, median progression‐free survival and overall survival were 8 and 26.5 months, respectively. Multivariate analysis showed that chemosensitivity to treatment administered before BV was associated with a significantly increased probability of achieving response to BV (P = .005). Bulky disease (P = .01) and response to BV (P <.001) were significant for progression‐free survival, while refractoriness to most recent treatment (P = .04), bulky disease (P = .005), and B‐symptoms (P = .001) were unfavorable factors for overall survival. Among the 22 CRs, 5 remain in CR with no further treatment after BV at a median follow‐up of 13 months. In conclusion, our data indicate that BV is an effective treatment for R/R HL patients even outside clinical trials. Whether BV can cure a fraction of patients remains to be seen.
Highlights
For patients who relapse after autologous hematopoietic stem cell transplantation (ASCT), conventional chemotherapy options are usually unsatisfactory, and their outcome is rather dismal with a median overall survival (OS) of 2 years.[6,7]
A multicenter phase II trial of Brentuximab vedotin (BV) in patients with Hodgkin lymphoma (HL) recurring after ASCT demonstrated an overall response rate (ORR) and complete response (CR) rate of 75% and 34%, respectively,[10] with a median progression‐free survival (PFS) extending to 9.3 months.[11]
The following covariates were entered in the multivariate analysis model: age at BV initiation, gender, number of treatments administered before BV ( 3), response to initial treatment, response to the last chemotherapy regimen administered before BV, disease stage (I/II vs III/IV), bulky disease, extranodal involvement and B‐symptoms at BV initiation, previous ASCT, and response to BV (CR vs partial response [PR]) vs no response]
Summary
Salvage chemotherapy followed by high‐dose therapy and autologous hematopoietic stem cell transplantation (ASCT) is the treatment of choice for relapsed/refractory (R/R) Hodgkin lymphoma (HL) patients.[1,2,3] This therapeutic strategy can provide long‐term disease control in approximately 50% of R/R patients.[4,5] For patients who relapse after ASCT, conventional chemotherapy options are usually unsatisfactory, and their outcome is rather dismal with a median overall survival (OS) of 2 years.[6,7] Relapsed disease after ASCT is considered incurable, unless allogeneic transplantation is applied. We wanted to report the pattern of its use, to identify possible prognostic factors and investigate whether a fraction of patients can achieve long‐term disease control with BV as the sole treatment
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