How effective is BV-DHAP chemotherapy to treat patients with relapsed or refractory Hodgkin lymphoma?

This study examined the effectiveness and safety of the chemotherapy combination BV-DHAP for patients with relapsed or refractory Hodgkin lymphoma (HL). The authors found that BV-DHAP was an effective and safe treatment to progress patients to high-dose chemotherapy and stem cell transplant.

During treatment, some patients with HL do not respond (refractory), while the cancer returns after treatment in other patients (relapse). Patients with relapsed or refractory HL must be given more aggressive treatment. This usually involves initial chemotherapy (salvage). If patients respond well, high-dose chemotherapy and stem cell transplant (SCT) are also given. 

Dexamethasone (Decadron), cisplatin (Platinol), and cytarabine (Cytosar), or DHAP, is one of the most commonly used salvage chemotherapy combinations. Brentuximab vedotin (Adcetris), or BV, is a drug that is also used to treat patients with relapsed or refractory HL. It is unknown if BV can improve the effectiveness of DHAP and if this is safe for patients.

55 patients with relapsed or refractory HL were given BV-DHAP. 89% of patients completed BV-DHAP treatment. 85% of patients progressed to high-dose chemotherapy and SCT. Patients were followed for an average of 27 months.

90% of patients responded to BV-DHAP treatment. 81% of patients had a complete response (CR; no detectable cancer by the time treatment finished). 10% of patients (5 patients) had a partial response (PR; shrinkage of the tumor). After finishing high-dose chemotherapy and SCT, 4 of the 5 patients with a partial response no longer had any detectable cancer (CR). 

After 2 years, 94.9% of patients survived. 73.5% of patients had not seen a return or worsening of HL. Patients who had a CR to BV-DHAP treatment were 6.02 times more likely to survive without cancer worsening than those who had a partial response.

During BV-DHAP treatment, 20 patients (36%) experienced significant side effects. Low white blood cells with a fever was the most common side effect (14 patients). 18 patients developed problems with their nerves but recovered once treatment finished.

The authors concluded that BV-DHAP is an effective and safe chemotherapy combination for patients with relapsed or refractory HL.

The manufacturer of brentuximab vedotin, Takeda, funded this research. No comparison treatment was used in this study. The results of this study should be confirmed with a larger number of patients.