Abstract
The optimal salvage therapy in relapsed/refractory Hodgkin lymphoma (R/R HL) has not been defined so far. The goal of this multicenter retrospective study was to evaluate efficacy and safety of BGD (bendamustine, gemcitabine, dexamethasone) as a second or subsequent line of therapy in classical R/R HL. We have evaluated 92 consecutive R/R HL patients treated with BGD. Median age was 34.5 (19–82) years. Fifty-eight patients (63%) had received 2 or more lines of chemotherapy, 32 patients (34.8%) radiotherapy, and 21 patients (22.8%) an autologous hematopoietic stem cell transplantation (autoHCT). Forty-four patients (47.8%) were resistant to first line of chemotherapy. BGD therapy consisted of bendamustine 90 mg/m2 on days 1 and 2, gemcitabine 800 mg/m2 on days 1 and 4, dexamethasone 40 mg on days 1–4. Median number of BGD cycles was 4 (2–7). The following adverse events ≥ 3 grade were noted: neutropenia (22.8%), thrombocytopenia (20.7%), anemia (15.2%), infections (10.9%), AST/ALT increase (2.2%), and skin rush (1.1%). After BGD therapy, 51 (55.4%) patients achieved complete remission, 23 (25%)—partial response, 7 (7.6%)—stable disease, and 11 (12%) patients experienced progression disease. AutoHCT was conducted in 42 (45.7%) patients after BGD therapy, and allogeneic HCT (alloHCT) in 16 (17.4%) patients. Median progression-free survival was 21 months. BGD is a highly effective, well-tolerated salvage regimen for patients with R/R HL, providing an excellent bridge to auto- or alloHCT.
Highlights
MethodsHodgkin lymphoma (HL), accounting for approximately 10% of all lymphomas, is one of the most curable malignancies
The Polish Lymphoma Research Group (PLRG) proposed replacement of vinorelbine with dexamethasone and is carrying out a prospective, multicenter study in patients with progressive disease during or after ABVD treatment [15] based on the very good preliminary results obtained with BGD in heavily pretreated R/R HL patients [16]
We retrospectively reviewed the data of all patients aged ≥ 18 years with R/R HL who were treated with BGD regimen between April 2012 and December 2018 in 15 centers allied within the PLRG
Summary
MethodsHodgkin lymphoma (HL), accounting for approximately 10% of all lymphomas, is one of the most curable malignancies. Due to rather low rate of complete responses (CRs) achieved with the most frequently used salvage regimens, there is the persisting need to develop new salvage regimens especially in the second-line treatment. Bendamustine both in monotherapy and in combination with other drugs was shown to induce high response rates with an acceptable toxicity profile in third or more line in patients with relapsed/refractory (R/R) HL [11,12,13]. Santoro et al modified their original IGEV protocol substituting ifosfamide with bendamustine achieving a very high efficacy as a second-line therapy in patients with R/R HL [9, 14]. We report long-term outcome of these patients enrolled to the multicenter retrospective PLRG study aiming at evaluating the efficacy and toxicity of BGD in a real-life setting
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