A Retrospective Study of 108 Cases of Relapsed or Refractory Classical Hodgkin Lymphoma: Second Line Therapies and Autologous Hematopoietic Stem Cell Transplantation

Objective: To investigate the efficacies of different second-line therapies and outcomes of relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL).

Methods: From 2008 to 2017, 108 R/R cHL patients received second line therapies at Lymphoma Department of Peking University Cancer Hospital. We retrospectively reviewed the clinical data and outcomes.

Results: Among 108 patients, 74 (68.5%) were male. At the time of cHL diagnosis, the median age was 28 years; 48 (44.4%) patients were stage Ⅰ-Ⅱ and 60 (55.6%) patients were stage Ⅲ-Ⅳ. 79 (73.1%) patients were primary refractory while 29 (26.9%) patients relapsed after initial therapy. The overall response rate (ORR) of 108 cases was 66.7% of second-line salvage therapy. Only 29 (26.9%) patients achieved complete remission (CR). 20 patients achieved CR or PR at two cycles of salvage therapy but developed progressive disease after four cycles. 82 (75.9%) patients received DICE regimen (dexamethasone, ifosfamide, cisplatin and etoposide) or ICE regimen (ifosfamide, carboplatin and etoposide) as salvage therapy, 11 (10.2%) patients received ABVD regimen (adriamycin, bleomycin, vincristine, dacarbazine) or BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), 12 (11.1%) patients received GemOx regimen (gemcitabine and oxaliplatin) or GDP regimen (gemcitabine, cisplatin and dexamethasone), 3 (2.8%) patients received other chemotherapy. The ORR of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 72%, 81.8% and 16.7% (p=0.001). With a median follow-up time of 34 months, the 3-year overall survival (OS) rate and 3-year progression-free survival (PFS) rate of all patients were expected to be 83% and 58.5%. The 3-year OS rate of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 83.2%, 81.8% and 71.3% (p=0.572). The 3-year PFS rate of DICE/ICE, ABVD/BEACOPP and GemOx/GDP group were 63.7%, 63.6% and 40% (p=0.157). 60 (55.6%) patients received autologous hematopoietic stem cell transplantation (AHSCT) and 3-year OS was 90.4%, which showed a significant survival improvement as compared with patients without AHSCT (3-year OS 72.6%, p=0.013).

Conclusion: In this study, DICE/ICE regimen as second-line salvage therapy for R/R cHL was more effective than GemOx/GDP regimen. AHSCT could significantly improve survival of R/R cHL.