Background:Brentuximab Vedotin (BV) is an active drug in patients with relapsed / refractory (R/R) Hodgkin Lymphoma (HL). Autologous stem cell transplantation (ASCT) remains standard of care for these patients and achieving a clinical response pre-ASCT predicts favorable outcomes. Pre-ASCT salvage chemotherapy combinations with BV have been explored in this setting.
Objective:To evaluate the efficacy and safety of the combination of BV and chemotherapy in heavily pretreated R/R HL patients eligible for ASCT.
Methods:We reviewed the clinical characteristics, treatment, response, safety, and survival of 21 heavily pretreated R/R HL patients in 2 Peruvian institutions between June 2018 and February 2020. Survival curves were estimated using the Kaplan-Meier method.
Results:A total of 21 patients (15 (71%) refractory and 6 (29%) relapsed) were included. The median age was 31 years (range, 19-55), 13 (62%) patients were female. The median of previous treatment lines was 3 (range, 1-4).
Patients received BV plus chemotherapy (CT) on day 1: Dexamethasone, Cytarabine and Cisplatin (DHAP) (43%), Gemcitabine-based CT (33%), Ifosfamide, Carboplatin and Etoposide (ICE) (14%), and other CT (ESHAP, Bendamustine) (10%).
After a median of 3 cycles of combination therapy (range, 2-7), the objective response rate was 81 %, with 8 (38%) patients achieving CR. 10 (48%) patients had successful peripheral blood stem cell (PBSC) collection. 7 (33%) patients underwent ASCT, the remaining responding patients had a delay in either collection or ASCT due to COVID-19 pandemic.
The most significant adverse events were thrombocytopenia (69%) (G3-4: 53%), neutropenia (47%) (G3-4: 28%), infections (37%), febrile neutropenia (33%) and G1-2 peripheral neuropathy (16%).
The Progression Free-Survival (PFS) at 1 year was 86% in ASCT patients.
Conclusion:The combination of Brentuximab and chemotherapy is active as a bridge for ASCT in heavily pretreated R/R HL patients. The CR rates were lower than previously reported and it could be related with the number of previous lines of treatment received; there was also a higher incidence of febrile neutropenia in our cohort. We could hypothesize that the combination of Brentuximab and chemotherapy provides greater benefit if it is administered earlier in patients with R/R HL.
No relevant conflicts of interest to declare.
