Abstract
Context The standard treatment for Hodgkin lymphoma (HL) patients presenting a relapsed/refractory disease is salvage chemotherapy followed by autologous stem cell transplantation (ASCT). However, with commonly used chemotherapy combinations (such as DHAP, ICE, BEGEV), 25–30% of these patients fail to achieve a complete metabolic response (CMR) and to proceed to ASCT, with consequently poor outcomes. Single agents brentuximab vedotin (BV) and pembrolizumab have shown efficacy in heavily pretreated HL patients, as reported in previous studies. Objective To describe the outcome of a series of refractory HL patients with a combination of brentuximab vedotin and pembrolizumab. Patients We retrospectively collected data of seven HL patients presenting with a high-risk multi-refractory disease (at least two prior treatments received) followed at Jules Bordet Institute between May 2019 and May 2020 and treated with a combination of BV and pembrolizumab. Patients were treated according to special insurance conditions permitting treatment reimbursement. Interventions We planned to treat patients with 3-week cycles of a combination of BV and pembrolizumab, performing an early PET-CT evaluation followed by high-dose chemotherapy and ASCT consolidation for those achieving a CMR (Deauville score ≤3). After ASCT, patients received BV as maintenance for a total of 16 administration (also including pre-ASCT cycles). Main outcome measures The rate of CMR and the percentage of patients achieving ASCT. Results We included 7 patients, 6 male and 1 female, with a mean age of 27.4 years. All patients presented with an advanced-stage disease, with a mean number of received treatments of 2.56 (range 2–3). The mean follow-up time was 7.1 months, the average received cycles of treatment were 4.2 (range 2–7). A CMR was achieved in five patients (72%), with a median time to response of two cycles. One partial response and one disease progression were also observed. Five patients proceeded to ASCT (72%) and subsequent BV maintenance, with no reported disease progressions in this group. One patient achieving a CMR after two cycles subsequently lost the response and failed to proceed to ASCT. Conclusions The BV and pembrolizumab combination seems to be effective as bridge to ASCT for high-risk multi-refractory HL patients.
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