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DISEASE CHARACTERISTICS AND SURVIVAL AFTER 3RD RECURRENCE OF CLASSICAL HODGKIN LYMPHOMA: AN ANALYSIS OF THE GERMAN HODGKIN STUDY GROUP
Author(s):
Paul J. Bröckelmann
,
Paul J. Bröckelmann
Affiliations:
Department I of Internal Medicine and German Hodgkin Study Group (GHSG),University Hospital of Cologne,Cologne,Germany
Horst Müller
,
Horst Müller
Affiliations:
Department I of Internal Medicine and German Hodgkin Study Group (GHSG),University Hospital of Cologne,Cologne,Germany
Esra Kücüksarioglan
,
Esra Kücüksarioglan
Affiliations:
Department I of Internal Medicine and German Hodgkin Study Group (GHSG),University Hospital of Cologne,Cologne,Germany
Andreas Engert
,
Andreas Engert
Affiliations:
Department I of Internal Medicine and German Hodgkin Study Group (GHSG),University Hospital of Cologne,Cologne,Germany
Bastian von Tresckow
Bastian von Tresckow
Affiliations:
Department I of Internal Medicine and German Hodgkin Study Group (GHSG),University Hospital of Cologne,Cologne,Germany
(Abstract release date: 05/18/17) EHA Library. Bröckelmann P. 06/24/17; 181701; S414
Dr. Paul Bröckelmann
Dr. Paul Bröckelmann
Contributions
PDF Abstract
Abstract

Abstract: S414

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 12:00 - 12:15

Location: Hall B

Background
Data on disease presentation, therapeutic options and survival after 3rd or higher relapse of classical Hodgkin lymphoma (cHL) are sparse. Therefore the additional benefit of new agents, which are usually initially investigated after several relapses of cHL, is difficult to estimate.

Aims
The aim of this study was to define and describe a historical control group in European patients from the German Hodgkin Study Group (GHSG) data for comparison of safety and efficacy of novel therapeutic agents.

Methods
Cases with at least three consecutive tumor-related events, either progressive refractory or relapsed disease, were identified in the GHSG database. Detailed information was added from case report forms and physician’s letters. Overall survival (OS) was the main and progression free survival (PFS), response to therapy, adverse events, disease and treatment characteristics as secondary endpoints.

Results

Among 12,584 HL patients in the GHSG first-line trials HD7 to HD15 and 449 HL patients in the trials HDR1 and HDR2 a total of 69 cHL patients with ≥3 tumor events were identified. The dates of occurrence of 3rd relapse ranged between 15th of January 1993 and 21st of June 2013. The sample consisted of 51 male (74%) and 18 female (26%) patients. At time of 3rd relapse the age of the patients ranged from 20 to 79 years (mean 39.2 years, standard deviation (SD) 14.0 years) and the majority of patients presented with stage III or IV disease (67%). Time from end of 3rd-line treatment to 3rd relapse was ≤ 3 months (i.e. GHSG definition of refractory disease) in 15 cases (22%), ≤ 12 months (early relapse) in 19 cases (28%) and > 12 months (late relapse) in 35 cases (51%). All 69 patients were pretreated with chemotherapy, 35 (50.7%) with BEACOPP, 30 (43.5%) with ABVD and no BEACOPP, and 32 (46.6%) with another type of chemotherapy. The number of prior chemotherapies ranged from one to three (median 3). Pretreatment with radiotherapy was observed in 57 (82.6%) patients, with salvage chemotherapy aimed to induce a remission prior to a stem-cell transplantation (SCT) in 58 (84.1%), and with high dose chemotherapy followed by autologous SCT in 50 (72.5%) patients. Four patients (5.8%) had received allogeneic SCT as 3rd-line treatment. None of the patients had received brentuximab vedotin or anti-PD1 antibodies before 3rd relapse. With a median observation time of 63.3 months for OS after 3rd relapse, 45 patients (65.2%) had died and 60 (87.0%) had another PFS event. Twelve months after the 3rd relapse OS was 73.2% (95%>CI 62.6% to 83.8%) and PFS 50.8% (95%>CI 38.9% to 62.8%, Table 1).
Table1:
 
 
Progression Free Survival (PFS)
 
Overall Survival (OS)
 
 
%
95% confidence-interval
 
%
95% confidence-interval
events
Lower limit
Upper limit
events
Lower limit
Upper limit
 
 
 
 
 
 
 
 
 
6 months 
16
76.3%
66.1%
86.4%
7
89.6%
82.4%
96.9%
 
 
 
 
 
 
 
 
 
12 months 
33
50.8%
38.9%
62.8%
18
73.2%
62.6%
83.8%
 
 
 
 
 
 
 
 
 
18 months
47
29.5%
18.5%
40.5%
23
65.6%
54.2%
77.0%

Conclusion
Patients with a 3rd relapse or progression of cHL have a dismal, mostly palliative prognosis due to frequent tumor progression. Within one year half of the patients have a PFS event and one fourth die.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Relapsed lymphoma, Refractory, Hodgkin's Lymphoma, Survival

Abstract: S414

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 12:00 - 12:15

Location: Hall B

Background
Data on disease presentation, therapeutic options and survival after 3rd or higher relapse of classical Hodgkin lymphoma (cHL) are sparse. Therefore the additional benefit of new agents, which are usually initially investigated after several relapses of cHL, is difficult to estimate.

Aims
The aim of this study was to define and describe a historical control group in European patients from the German Hodgkin Study Group (GHSG) data for comparison of safety and efficacy of novel therapeutic agents.

Methods
Cases with at least three consecutive tumor-related events, either progressive refractory or relapsed disease, were identified in the GHSG database. Detailed information was added from case report forms and physician’s letters. Overall survival (OS) was the main and progression free survival (PFS), response to therapy, adverse events, disease and treatment characteristics as secondary endpoints.

Results

Among 12,584 HL patients in the GHSG first-line trials HD7 to HD15 and 449 HL patients in the trials HDR1 and HDR2 a total of 69 cHL patients with ≥3 tumor events were identified. The dates of occurrence of 3rd relapse ranged between 15th of January 1993 and 21st of June 2013. The sample consisted of 51 male (74%) and 18 female (26%) patients. At time of 3rd relapse the age of the patients ranged from 20 to 79 years (mean 39.2 years, standard deviation (SD) 14.0 years) and the majority of patients presented with stage III or IV disease (67%). Time from end of 3rd-line treatment to 3rd relapse was ≤ 3 months (i.e. GHSG definition of refractory disease) in 15 cases (22%), ≤ 12 months (early relapse) in 19 cases (28%) and > 12 months (late relapse) in 35 cases (51%). All 69 patients were pretreated with chemotherapy, 35 (50.7%) with BEACOPP, 30 (43.5%) with ABVD and no BEACOPP, and 32 (46.6%) with another type of chemotherapy. The number of prior chemotherapies ranged from one to three (median 3). Pretreatment with radiotherapy was observed in 57 (82.6%) patients, with salvage chemotherapy aimed to induce a remission prior to a stem-cell transplantation (SCT) in 58 (84.1%), and with high dose chemotherapy followed by autologous SCT in 50 (72.5%) patients. Four patients (5.8%) had received allogeneic SCT as 3rd-line treatment. None of the patients had received brentuximab vedotin or anti-PD1 antibodies before 3rd relapse. With a median observation time of 63.3 months for OS after 3rd relapse, 45 patients (65.2%) had died and 60 (87.0%) had another PFS event. Twelve months after the 3rd relapse OS was 73.2% (95%>CI 62.6% to 83.8%) and PFS 50.8% (95%>CI 38.9% to 62.8%, Table 1).
Table1:
 
 
Progression Free Survival (PFS)
 
Overall Survival (OS)
 
 
%
95% confidence-interval
 
%
95% confidence-interval
events
Lower limit
Upper limit
events
Lower limit
Upper limit
 
 
 
 
 
 
 
 
 
6 months 
16
76.3%
66.1%
86.4%
7
89.6%
82.4%
96.9%
 
 
 
 
 
 
 
 
 
12 months 
33
50.8%
38.9%
62.8%
18
73.2%
62.6%
83.8%
 
 
 
 
 
 
 
 
 
18 months
47
29.5%
18.5%
40.5%
23
65.6%
54.2%
77.0%

Conclusion
Patients with a 3rd relapse or progression of cHL have a dismal, mostly palliative prognosis due to frequent tumor progression. Within one year half of the patients have a PFS event and one fourth die.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Relapsed lymphoma, Refractory, Hodgkin's Lymphoma, Survival

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