Contributions
Abstract: EP770
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Brentuximab vedotine (BV) has shown a high overall response rate in refractory/relapsed Hodgkin lymphoma (r/r cHL) with reported stable remissions achieved in pivotal clinical trial. However, only limited data is available regarding its role in role-term outcomes in real life clinical practice in light of recent treatment landscape shift due to the introduction of immune checkpoint inhibitors.
Aims
-
Methods
This retrospective analysis included patients with r/r cHL (n= 131) treated with BV – containing regimens in Pavlov University clinic from 2012 to 2020. Median age at BV- treatment was 28 year (range, 16-50). Seventy two percent of pts had advanced stages at BV- treatment. 61% of pts had primary refractory disease. ASCT was performed in 47,3% of patients prior BV- therapy. Median number of previous therapy lines was 4 (3-11). BV was used a monotherapy in 100 pts (76,3%) and in combination with bendamustine in 31 pts (23,6%). Median number of treatment cycles was 4 (range, 3-11). Dose of BV was 1,8mg/kg for all pts; dose of bendamustine was 90mg/m2 in day 1 and 2 of the 21 day cycle.
Results
At the time of analysis the median follow- up for alive pts (n=95) was 48,9 (3,0-104,6) months. Overall response rate was 61,0% (80 pts): CR in 38,9% (51 pts) and PR in 22,1% (29 pts). The duration of response for these pts was 11,1mo (1-101,4 months). Most of patients (93,1%, n=122) received additional therapy after BV-based treatment. The type of next therapy was BV-retreatment in 14,7% (18 pts), PD-1 inhibitors in 44,2% (54 pts), allogeneic stem cell transplantation (allo SCT) in 23,7% (29 pts), chemotherapy in 17,2% (21 pts). Overall, 58 pts were treated with anti PD-1 therapy at various time point after BV-based treatment.
The median overall survival (OS) was not reached and 5-year OS was 75,6%. The median progression free survival (PFS) was 6,0 mo (4,7-7,3 months) and 5- year PFS was 24,4%. At the moment of analysis, nine pts (6,8%) were in a remission after BV with no additional treatment.
Among factors significantly associated with favorable prognosis regarding the OS were PD-1 treatment after BV (5- year OS 89,7% vs 58,9%, p=<0,001) and consolidation by allo-SCT (5- year OS 82,8% vs 69,6%, p=0,049). Regarding PFS, the consolidation of remission by allo-SCT was significantly associated with favorable prognosis (5-year PFS 72,4% vs 10,8%, p=< 0,001)
Importantly, there was no benefit of combined regimens of BV+Bendamustine vs BV- monotherapy (5- year PFS of 30% vs 21,8%, p= 0,149), nor the overall response rate, p=0,881).
Conclusion
Brentuximab vedotin based regimens are highly active in inducing response in patients with r/r cHL with only modest potential achieve sustained remissions. There was no significant benefit of BV-benda combination regarding the PFS when compared to BVmonotherapy in the analyzed patient population. The outcomes of patients after BV treatment in the era of immunotherapy are more favorable than in registration studies, with significant advantage regarding OS in patients receiving anti-PD-1 treatment after BV failure. The alloHSCT represents an important approach for consolidation of response achieved with BV treatment, however the optimal strategy regarding the alloHSCT remains to be defined in prospective randomized trials.
Keyword(s): Allo-SCT, Hodgkin's lymphoma, Immunotherapy
Abstract: EP770
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
Brentuximab vedotine (BV) has shown a high overall response rate in refractory/relapsed Hodgkin lymphoma (r/r cHL) with reported stable remissions achieved in pivotal clinical trial. However, only limited data is available regarding its role in role-term outcomes in real life clinical practice in light of recent treatment landscape shift due to the introduction of immune checkpoint inhibitors.
Aims
-
Methods
This retrospective analysis included patients with r/r cHL (n= 131) treated with BV – containing regimens in Pavlov University clinic from 2012 to 2020. Median age at BV- treatment was 28 year (range, 16-50). Seventy two percent of pts had advanced stages at BV- treatment. 61% of pts had primary refractory disease. ASCT was performed in 47,3% of patients prior BV- therapy. Median number of previous therapy lines was 4 (3-11). BV was used a monotherapy in 100 pts (76,3%) and in combination with bendamustine in 31 pts (23,6%). Median number of treatment cycles was 4 (range, 3-11). Dose of BV was 1,8mg/kg for all pts; dose of bendamustine was 90mg/m2 in day 1 and 2 of the 21 day cycle.
Results
At the time of analysis the median follow- up for alive pts (n=95) was 48,9 (3,0-104,6) months. Overall response rate was 61,0% (80 pts): CR in 38,9% (51 pts) and PR in 22,1% (29 pts). The duration of response for these pts was 11,1mo (1-101,4 months). Most of patients (93,1%, n=122) received additional therapy after BV-based treatment. The type of next therapy was BV-retreatment in 14,7% (18 pts), PD-1 inhibitors in 44,2% (54 pts), allogeneic stem cell transplantation (allo SCT) in 23,7% (29 pts), chemotherapy in 17,2% (21 pts). Overall, 58 pts were treated with anti PD-1 therapy at various time point after BV-based treatment.
The median overall survival (OS) was not reached and 5-year OS was 75,6%. The median progression free survival (PFS) was 6,0 mo (4,7-7,3 months) and 5- year PFS was 24,4%. At the moment of analysis, nine pts (6,8%) were in a remission after BV with no additional treatment.
Among factors significantly associated with favorable prognosis regarding the OS were PD-1 treatment after BV (5- year OS 89,7% vs 58,9%, p=<0,001) and consolidation by allo-SCT (5- year OS 82,8% vs 69,6%, p=0,049). Regarding PFS, the consolidation of remission by allo-SCT was significantly associated with favorable prognosis (5-year PFS 72,4% vs 10,8%, p=< 0,001)
Importantly, there was no benefit of combined regimens of BV+Bendamustine vs BV- monotherapy (5- year PFS of 30% vs 21,8%, p= 0,149), nor the overall response rate, p=0,881).
Conclusion
Brentuximab vedotin based regimens are highly active in inducing response in patients with r/r cHL with only modest potential achieve sustained remissions. There was no significant benefit of BV-benda combination regarding the PFS when compared to BVmonotherapy in the analyzed patient population. The outcomes of patients after BV treatment in the era of immunotherapy are more favorable than in registration studies, with significant advantage regarding OS in patients receiving anti-PD-1 treatment after BV failure. The alloHSCT represents an important approach for consolidation of response achieved with BV treatment, however the optimal strategy regarding the alloHSCT remains to be defined in prospective randomized trials.
Keyword(s): Allo-SCT, Hodgkin's lymphoma, Immunotherapy