Contributions
Type: Publication Only
Background
Although Hodgkin's lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only in 50% of these patients will effective salvage be achieved with conventional therapies. The prognosis is particularly poor for those patients who are refractory or relapse following an autologous stem cell transplant (ASCT). Reduced-intensity conditioning (RIC) is increasingly used as a potentially curative option.
Aims
We performed a retrospective analysis of 25 adult patients (15 women/10 men) with HL, who relapsed within 12 months or had progressive disease after ASCT, in order to analyze clinical outcome.
Methods
Disease status at ASCT was complete remission in 7 patients (28%), sensitive disease in 14 (56%), and refractory disease in 4 (16 %). Median time from ASCT to relapse was 7 months (range 0.5-11); 12 patients (48%) had stage 3-4 at relapse/progression. B symptoms were present in 40% of the patients, bulky disease in 20% and extranodal involvement in 56%. Treatments following relapse/progression were the standard BEACOPP regimen in 10 patients (40%), 2nd ASCT in 5 (20%), brentuximab vedotin without further therapy in 2 (8%) and RIC in 8 (32%); the therapeutic regimens used as a “bridge” to RIC were brentuximab vedotin in 6 (24%) and bendamustine in 2 (8%).
Results
Overall response rate was 64%, including 36% complete remission and 28% partial response. Progression occurred in 24% and 12% had stable disease. No difference in response rate was found among the treatment regimens. RIC was administered in 8 patients (4 in complete and 4 in partial remission). Estimated overall survival at 40 months was 72% for the whole population, 88% for patients who underwent RIC and 58% for those who did not. Estimated progression-free survival at 40 months was 50%; 62% for the RIC group and 42% for the non RIC group. After a median follow-up of 36 months (range 3-84), 18 of the 25 patients are alive (72%) and 11 (44%) still in complete remission (45% of them underwent RIC).
Summary
Patients with HL who fail ASCT have a very poor prognosis, and the goal of treatment should be to ultimately refer them to RIC. Even if several questions are still open, this approach should be proposed for these poor prognosis patients. Brentuximab vedotin is useful in order to reduce the disease burden before RIC.
Session topic: Publication Only
Type: Publication Only
Background
Although Hodgkin's lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only in 50% of these patients will effective salvage be achieved with conventional therapies. The prognosis is particularly poor for those patients who are refractory or relapse following an autologous stem cell transplant (ASCT). Reduced-intensity conditioning (RIC) is increasingly used as a potentially curative option.
Aims
We performed a retrospective analysis of 25 adult patients (15 women/10 men) with HL, who relapsed within 12 months or had progressive disease after ASCT, in order to analyze clinical outcome.
Methods
Disease status at ASCT was complete remission in 7 patients (28%), sensitive disease in 14 (56%), and refractory disease in 4 (16 %). Median time from ASCT to relapse was 7 months (range 0.5-11); 12 patients (48%) had stage 3-4 at relapse/progression. B symptoms were present in 40% of the patients, bulky disease in 20% and extranodal involvement in 56%. Treatments following relapse/progression were the standard BEACOPP regimen in 10 patients (40%), 2nd ASCT in 5 (20%), brentuximab vedotin without further therapy in 2 (8%) and RIC in 8 (32%); the therapeutic regimens used as a “bridge” to RIC were brentuximab vedotin in 6 (24%) and bendamustine in 2 (8%).
Results
Overall response rate was 64%, including 36% complete remission and 28% partial response. Progression occurred in 24% and 12% had stable disease. No difference in response rate was found among the treatment regimens. RIC was administered in 8 patients (4 in complete and 4 in partial remission). Estimated overall survival at 40 months was 72% for the whole population, 88% for patients who underwent RIC and 58% for those who did not. Estimated progression-free survival at 40 months was 50%; 62% for the RIC group and 42% for the non RIC group. After a median follow-up of 36 months (range 3-84), 18 of the 25 patients are alive (72%) and 11 (44%) still in complete remission (45% of them underwent RIC).
Summary
Patients with HL who fail ASCT have a very poor prognosis, and the goal of treatment should be to ultimately refer them to RIC. Even if several questions are still open, this approach should be proposed for these poor prognosis patients. Brentuximab vedotin is useful in order to reduce the disease burden before RIC.
Session topic: Publication Only