ESAP-Lenalidomide - a Highly Active Regimen in Refractory or Relapsed Hodgkin's Lymphoma.

Abstract 4797

Hodgkin's disease (HD) is a commonly cured lymphoma. Unfortunately between 10 and 20% of patients are refractory or relapse after a first line of treatment. There is evidence that for these patients the best approach is salvage chemotherapy followed by high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT). Existing salvage regimens of chemotherapy, mainly based on platines or aracytine, have a response rate between 60-85%. Usually is associated a toxicity resulting in delay of chemotherapy or dose reduction. It is very important to achieve complete remission before HDC/ABSCT.

It has been proved that 18-FDG PET has a predictive value on Hodgkin's lymphoma.

Into the pathophysiology of HD are implicated various cytokines like IL6, IL12, IL13, NFkB and angiogenic factors. Immunomodulatory drugs have an impact on microenvironment, altering cytokine secretion and the expression of adhesion molecules which can result in apoptosis of malignant B-cell.

Lenalidomide, having both immunomodulatory and antiangiogenic activity, proved to be highly active into the treatment of myeloma and some forms of non-Hodgkin's lymphoma. Into a phase two studies, Lenalidomide administrated as a single agent, proves to be also active into the refractory or relapsed Hodgkin's lymphoma.

During a period of one year, we identified eight patients with refractory ore relapsed HD. We have treated these patients with classical salvage chemotherapy regimen – ESAP- in which we associated Lenalidomide, administrated continuously during the whole period of treatment. We evaluate the response by 18-FDG PET, early, after two or three cycles of ESAP-Lenalidomide association. We obtained seven complete remissions and one very good partial remission (minimal residual disease in PET SCAN). The toxicity was essentially hematological, neutropenia and trombocytopenia.

This small study proves that Lenalidomide, a new drug with both immunomodulatory and antiangiogenic effects, associated to a classical salvage regimen of chemotherapy is highly active on refractory or relapsing Hodgkin's lymphoma.