Abstract
Although autologous stem cell transplantation (auto-HCT) is the standard of care for patients with refractory/relapsed (R/R) classical Hodgkin’s lymphoma (cHL), there is still a significant proportion of patients that relapse after the procedure. This review contemplates different treatment strategies for patients with cHL that relapse or progress after auto-HCT. Allogeneic stem cell transplantation (allo-HCT) has, for many years, been the only curative option for this group of patients. Although the advent of haploidentical donors has allowed for the possibility to allograft almost all patients that are in need of it and to eventually improve historical results, allo-HCT is still associated with substantial morbidity and mortality. Brentuximab vedotin (BV) is an antibody drug conjugate that binds to CD30 antigen; BV is able to give up to 34% metabolic complete remissions (mCR) in HL patients that fail auto-HCT. Unleashing the immune system with PD-1 inhibitors has resulted in remarkable responses in a number of malignancies, including HL. Nivolumab and pembrolizumab offer a 20%–25% mCR and 40%–50% partial remissions, with an acceptable safety profile. R/R cHL do have several options nowadays that, without any doubt, have significantly improved the long-term outcome of this hard-to-treat population.
Highlights
Most patients with classical Hodgkin’s lymphoma can be cured with conventional chemotherapy (CT) ± radiotherapy (RT) [1,2]
Brentuximab Vedotin (BV) is a conjugated anti-CD30 monoclonal antibody that was approved in 2011 by both the FDA and European Medical Agency (EMA) for the treatment of patients that relapse after auto-HCT or that did not respond to two prior lines of chemotherapy and were not considered suitable for an auto-HCT
Retreatment with brentuximab vedotin (BV) monotherapy was investigated in patients with classical Hodgkin’s lymphoma (cHL) or systemic anaplastic large cell lymphoma (ALCL) that relapsed after achieving complete remission (CR) or a partial remission (PR) with initial BV therapy [16]
Summary
Most patients with classical Hodgkin’s lymphoma (cHL) can be cured with conventional chemotherapy (CT) ± radiotherapy (RT) [1,2]. Autologous hematopoietic stem cell transplantation (auto-HCT) is the standard of care for the majority of relapsed/refractory (R/R) cHL patients on the basis of two randomized trials that showed significant benefits for auto-HCT over conventional CT for relapsed diseases [3,4]. A significant proportion of patients can be cured with high-dose therapy and auto-HCT, up to 50% of them still relapse. The landscape of R/R cHL treatment has changed significantly since the approval of brentuximab vedotin (BV) in 2011 for the treatment of patients who are not candidates for auto-HCT after at least two lines of chemotherapy and for treating patients that fail auto-HCT [7]. We intend to summarize the recent advances in therapy for patients with cHL who fail auto-HCT
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