The use of brentuximab vedotin before transplant for patients with Hodgkin’s lymphoma

This study aimed to compare outcomes for patients with Hodgkin’s lymphoma who received brentuximab vedotin (Adcetris) compared to chemotherapy before a stem cell transplant. This study concluded that patients who received brentuximab vedotin had a better survival.

Allogeneic hematopoietic stem cell transplant (allo-HSCT) is a potentially curative therapy for patients with relapsed/unresponsive Hodgkin’s lymphoma (HL). Allo-HSCT is a procedure where the patient receives blood-forming stem cells from a non-identical donor such as a sister or brother. Reduced-intensity conditioning (RIC) uses a reduced dose of chemotherapy before an allo-HSCT. It aims to prevent graft-versus-host disease (GvHD). GvHD occurs when the stem cells view the body as foreign and begin to attack it.

Brentuximab vedotin (BV) is an antibody-drug conjugate that can be used to treat HL. It specifically targets lymphoma cells. It is not known if patients who receive BV would benefit more before allo-HSCT when compared to receiving RIC.

This study involved 72 patients with classical HL who received allo-HSCT. 21 patients were pre-treated with BV and 51 patients received RIC. Patients were followed up for an average of 60 months.

The use of BV had no significant effect on engraftment (cells received during transplant start to grow and make healthy blood cells) or the occurrence and severity of acute GvHD. At 3 years, 43% of the BV group developed chronic GvHD compared to 47% in the no BV group.

The 3-year survival rate without cancer getting worse was 53% for the BV group compared to 33% in the no BV group. The 3-year overall survival rate was 62% for the BV group compared to 44% for the no BV group.

At the time of transplant, in patients who did not respond to chemotherapy, survival without cancer getting worse was significantly higher for the BV group (51%) compared to the no BV group (10%). Overall survival at 3 years for these patients was 59% in the BV group compared to 20% in the no BV group.

This study concluded that patients with HL who do not respond to chemotherapy have better survival with BV treatment.

This study had a small number of patients and unequal groups. Larger studies are needed for stronger evidence.