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TREATMENT PATTERNS AND EFFECTIVENESS OUTCOMES IN PATIENTS WITH RELAPSED/REFRACTORY CLASSICAL HODGKIN'S LYMPHOMA WHO RECEIVED AUTOLOGOUS AND/OR ALLOGENIC STEM CELL TRANSPLANTATION
Author(s): ,
Shahed Iqbal
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
,
Monika Raut
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
,
Adrienne Gilligan
Affiliations:
Outcomes Science & Services,Concerto HealthAI,Memphis,United States
,
Nicole Clarke
Affiliations:
Outcomes Science & Services,Concerto HealthAI,Memphis,United States
,
Shuvayu Sen
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
,
Kaushal Desai
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
,
Xiaoqin Yang
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
Akash Nahar
Affiliations:
Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.,Whitehouse Station,United States
(Abstract release date: 05/14/20) EHA Library. Raut M. 06/12/20; 293640; EP1151
Monika Raut
Monika Raut
Contributions
Abstract

Abstract: EP1151

Type: e-Poster

Background
While classical Hodgkin’s lymphoma (cHL) is seeing increasing survival rates, patients with multiple relapses (including patients with transplant), require several lines of treatment. Treatment patterns and overall survival (OS) for relapsed/refractory (R/R) cHL patients pre- and post-transplant in the real world are currently less understood.

Aims
To evaluate patient characteristics, treatment patterns and OS of R/R cHL patients who received autologous (auto-SCT) and/or allogenic (allo-SCT) stem cell transplants.

Methods
This retrospective study used US electronic health record data from the Definitive Oncology Dataset. Patients with confirmed cHL, age ≥18, and ≥1 R/R event that occurred from 2000 to 2019 were included. Patients were grouped by auto-SCT vs. no auto-SCT and allo-SCT. OS was measured from the first R/R-event (2L [first R/R event], 3L [second R/R event], and 4L [third R/R event]); patients without evidence of death were censored at the last observed visit.

Results
A total of 157 R/R cHL patients (54.9%) received auto-SCT (n=286). Auto-SCT patients were significantly (p<0.05) younger (median age: 31 vs. 46 years), had fewer comorbidities (90.4% vs. 73.6% with no comorbidities), and fewer B symptoms (fatigue: 24.2% vs. 31.0%; fevers: 21.7% vs. 32.6%; chills: 5.7% vs. 10.1%; night sweats: 37.6% vs. 40.3%; weight loss: 30.6% vs. 43.4%) compared to patients with no auto-SCT. Among auto-SCT patients, 9.6% (n=15) also received allo-SCT in later lines. Nearly all patients (91.7%) received auto-SCT after the start of 2L (68.2%, n=107) and 3L (23.6%, n=37). Patients who received auto-SCT in 2L (n=107) were almost all (92.5%) treated with a doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD)-containing regimen prior to transplant. Of the 40.2% (n=43) who received treatment in 3L after auto-SCT, 34.9% (n=15) were treated with a brentuximab vedotin (BV)-containing regimen. Patients with auto-SCT in 3L were mostly treated with an ifosfamide/carboplatin/etoposide (ICE)-containing regimen in 2L (61.5%, n=16). Of the 29.9% (n=47) who received treatment in 4L after auto-SCT, 31.9% (n=15) were treated with a BV-containing regimen. Across the 136 patients with auto-SCT who were treated in the R/R setting, 35 different anti-cancer regimens (monotherapy or in combination) were used in 2L, 35 in 3L, and 27 in 4L.

 

Only 6.6% (n=19) of patients received allo-SCT. Most patients received allo-SCT after the start of 3L and 4L (73.6%, n=14). Patients with allo-SCT in 3L (36.8%, n=7) were mainly treated with ICE-containing regimens (85.7%, n=6) in 2L and BV or dexamethasone (28.6%, n=2) in 4L post-transplant. Patients with allo-SCT in 4L (36.8%, n=7) were treated with BV (14.3%, n=1), gemcitabine/vinorelbine/doxorubicin (GVD) (28.6%, n=2), cisplatin/cytarabine/ etoposide/methylprednisolone (ESHAP), or ifosfamide/gemcitabine/prednisone/vinorelbine (IGEV) (all 14.3%, n=3) in 3L.

 

Median OS in 2L-4L was 146.7, 116.6, and 81.7 months for auto-SCT patients and was 29, 82, and 46 months longer compared to those without auto-SCT (p<0.01 for all values). For allo-SCT patients, median OS in 2L-4L was not achieved, 75.2, and 48.8 months, respectively.

Conclusion
In the real-world setting, over half of R/R cHL patients received auto-SCT (mainly between their first and second R/R event) while few patients received allo-SCT. Patients with auto-SCT had a longer survival compared to those without a transplant. There appears to be no clear standard of care post-transplant, particularly in later lines of therapy, highlighted by the range of regimens.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Allogeneic hematopoietic stem cell transplant, Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Relapsed lymphoma

Abstract: EP1151

Type: e-Poster

Background
While classical Hodgkin’s lymphoma (cHL) is seeing increasing survival rates, patients with multiple relapses (including patients with transplant), require several lines of treatment. Treatment patterns and overall survival (OS) for relapsed/refractory (R/R) cHL patients pre- and post-transplant in the real world are currently less understood.

Aims
To evaluate patient characteristics, treatment patterns and OS of R/R cHL patients who received autologous (auto-SCT) and/or allogenic (allo-SCT) stem cell transplants.

Methods
This retrospective study used US electronic health record data from the Definitive Oncology Dataset. Patients with confirmed cHL, age ≥18, and ≥1 R/R event that occurred from 2000 to 2019 were included. Patients were grouped by auto-SCT vs. no auto-SCT and allo-SCT. OS was measured from the first R/R-event (2L [first R/R event], 3L [second R/R event], and 4L [third R/R event]); patients without evidence of death were censored at the last observed visit.

Results
A total of 157 R/R cHL patients (54.9%) received auto-SCT (n=286). Auto-SCT patients were significantly (p<0.05) younger (median age: 31 vs. 46 years), had fewer comorbidities (90.4% vs. 73.6% with no comorbidities), and fewer B symptoms (fatigue: 24.2% vs. 31.0%; fevers: 21.7% vs. 32.6%; chills: 5.7% vs. 10.1%; night sweats: 37.6% vs. 40.3%; weight loss: 30.6% vs. 43.4%) compared to patients with no auto-SCT. Among auto-SCT patients, 9.6% (n=15) also received allo-SCT in later lines. Nearly all patients (91.7%) received auto-SCT after the start of 2L (68.2%, n=107) and 3L (23.6%, n=37). Patients who received auto-SCT in 2L (n=107) were almost all (92.5%) treated with a doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD)-containing regimen prior to transplant. Of the 40.2% (n=43) who received treatment in 3L after auto-SCT, 34.9% (n=15) were treated with a brentuximab vedotin (BV)-containing regimen. Patients with auto-SCT in 3L were mostly treated with an ifosfamide/carboplatin/etoposide (ICE)-containing regimen in 2L (61.5%, n=16). Of the 29.9% (n=47) who received treatment in 4L after auto-SCT, 31.9% (n=15) were treated with a BV-containing regimen. Across the 136 patients with auto-SCT who were treated in the R/R setting, 35 different anti-cancer regimens (monotherapy or in combination) were used in 2L, 35 in 3L, and 27 in 4L.

 

Only 6.6% (n=19) of patients received allo-SCT. Most patients received allo-SCT after the start of 3L and 4L (73.6%, n=14). Patients with allo-SCT in 3L (36.8%, n=7) were mainly treated with ICE-containing regimens (85.7%, n=6) in 2L and BV or dexamethasone (28.6%, n=2) in 4L post-transplant. Patients with allo-SCT in 4L (36.8%, n=7) were treated with BV (14.3%, n=1), gemcitabine/vinorelbine/doxorubicin (GVD) (28.6%, n=2), cisplatin/cytarabine/ etoposide/methylprednisolone (ESHAP), or ifosfamide/gemcitabine/prednisone/vinorelbine (IGEV) (all 14.3%, n=3) in 3L.

 

Median OS in 2L-4L was 146.7, 116.6, and 81.7 months for auto-SCT patients and was 29, 82, and 46 months longer compared to those without auto-SCT (p<0.01 for all values). For allo-SCT patients, median OS in 2L-4L was not achieved, 75.2, and 48.8 months, respectively.

Conclusion
In the real-world setting, over half of R/R cHL patients received auto-SCT (mainly between their first and second R/R event) while few patients received allo-SCT. Patients with auto-SCT had a longer survival compared to those without a transplant. There appears to be no clear standard of care post-transplant, particularly in later lines of therapy, highlighted by the range of regimens.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Allogeneic hematopoietic stem cell transplant, Autologous hematopoietic stem cell transplantation, Hodgkin's lymphoma, Relapsed lymphoma

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