In a nutshell
This study aimed to evaluate high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) for the treatment of patients with high-risk relapse (HRR) classical Hodgkin’s lymphoma (cHL).
The authors concluded that the outcomes of patients with HRR cHL have improved over the last 15 years with HDC/ASCT.
Some background
HDC with ASCT is a standard treatment of relapsed cHL (cancer has returned). The BEAM regimen (carmustine, etoposide, cytarabine, melphalan) has long been the standard HDC combination for cHL. However, it has poorer effectiveness in patients with HRR.
Other HDC regimens are currently being tested to find the best HDC programs. Other HDC combinations include BuMel (busulfan and melphalan), GemBuMel (gemcitabine, busulfan, and melphalan), vGemBuMel (vorinostat and GemBuMel), avGemBuMel (azacytidine/vorinostat/GemBuMel). It is currently not known which regimen provides the best results in patients with HRR cHL.
Methods & findings
501 patients with HRR cHL were treated with HDC and ASCT. 189 received GemBuMel, 128 received vGemBuMel or avGemBuMel, 146 received BEAM and 38 received BuMel. 37 patients received maintenance brentuximab vedotin (BV; Adcedris). Maintenance therapy is meant to help initial therapy succeed (prevents relapse). The average follow-up period was 50 months.
Overall, the outcomes of patients tended to improve over the years. At 2 years, 73.2% of patients treated with (a)vGemBuMel, 57.3% of patients treated with GemBuMel, 56.3% of patients treated with BEAM, and 47.4% of patients treated with BuMel were alive without cancer worsening. At 5 years, 71.9% of patients treated with (a)vGemBuMel, 55% of patients treated with GemBuMel, 45% of patients treated with BEAM, and 38.9% of patients treated with BuMel were alive without cancer worsening.
Likewise, after 2 years, 93.8% of the (a)vGemBuMel group, 85.5% of the GemBuMel group, 75.2% of the BEAM group, and 78.9% of the BuMel group were alive. After 5 years, 87.3% of patients treated with (a)vGemBuMel, 75.5% of patients treated with GemBuMel, 60.8% of patients treated with BEAM, and 57.2% of patients treated with BuMel were alive.
Previous treatment with BV and (a)vGemBuMel were significantly associated with better survival. Lymphoma signs on PET scan after ASCT, bulky relapse, and 2 or more previous therapies were associated with worse outcomes.
The bottom line
The authors concluded that incorporating BV to before-ASCT therapy and the use of more active HDC regimens, particularly vorinostat/GemBuMel, were associated with improved outcomes in patients with HRR cHL.
The fine print
This study did not include those patients who failed to successfully undergo chemotherapy that is offered when cancer returns (salvage therapy).
Published By :
Haematologica
Date :
May 06, 2021
