Does brentuximab vedotin improve stem cell transplant outcomes for classical Hodgkin’s lymphoma patients?

This study investigated the outcomes of classical Hodgkin’s lymphoma (cHL) patients who did or did not receive brentuximab vedotin (Adcetris) before allogeneic stem cell transplantation. This study concluded that pre-transplant brentuximab vedotin treatment does not lead to better post-transplant outcomes.

Allogeneic stem cell transplantation (alloSCT, stem cells from a donor) is an effective therapy for HL patients who relapse after autologous SCT (autoSCT, stem cells from the patient). The success of alloSCT depends on the cancer being sensitive to pre-transplant salvage treatment (to get rid of remaining cancer cells). Unfortunately, patients with relapsed or refractory (does not respond to treatment) disease have already received several therapies. This makes it harder to treat them before a stem cell transplant.

Brentuximab vedotin is a monoclonal antibody. This type of treatment binds to cancer cells, leading to cancer cell death. Previous research has suggested that pre-transplant salvage treatment with brentuximab vedotin may improve transplant outcomes for these hard-to-treat HL patients.

This study involved 428 cHL patients who underwent ASCT. Of these, 210 patients received brentuximab vedotin before transplantation (BV group). 218 patients did not receive brentuximab vedotin (non-BV group). 78% of patients had already received an autoSCT. Patients were followed for an average of 41 months.

At an average of 12 months post-transplant, 28.6% of patients in the BV group received additional brentuximab vedotin treatment due to relapse. At an average of 22 months post-transplant, 13.8% of patients in the non-BV group also received brentuximab vedotin due to relapse.

Pre-transplant brentuximab vedotin was associated with a 36% decrease in risk of developing chronic graft-versus-host disease (GVHD; the immune system attacks the transplanted stem cells). Pre-transplant brentuximab vedotin did not affect progression-free survival (time from treatment before disease progression), overall survival (time from treatment until death from any cause), or risk of relapse. 

This study concluded that brentuximab vedotin treatment before ASCT does not lead to better outcomes. The authors suggest that brentuximab vedotin may help patients with refractory (does not respond to treatment) disease achieve a better disease status before a stem cell transplant.

This study looked back in time to analyze data collected from a registry. As a result, the collected data may be incomplete. Another limitation is the fact that patients in the BV group were more heavily treated compared to the non-BV group. More randomized studies comparing alloSCT patients with or without pre-transplant BV are needed to confirm these results.