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Posted by on Jul 9, 2019 in Hodgkin's lymphoma | 0 comments

In a nutshell

This article reviewed current treatment options for patients with Hodgkin lymphoma (HL) that has come back (relapsed) or stopped responding to treatment (refractory).

Some background

Chemotherapy remains the standard first-line treatment for HL. One of the most commonly used regimens is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). For most patients, first-line treatment is highly effective. However, 10 – 15% of patients with early-stage disease experience relapse or develop refractory disease. This rate can be up to 30% for patients with advanced-stage disease. There are several treatment options for these patients, including stem cell transplantation (SCT) and targeted therapy.

It is important to research the current treatment options for patients with relapsed or refractory HL.

Methods & findings

For younger patients with HL that still respond to chemotherapy, autologous SCT (autoSCT) is the next step. In autoSCT, high-dose chemotherapy is given first to get rid of any remaining cancer cells. Then, healthy stem cells are collected from the patient’s bloodstream. These cells are then introduced back to the patient. In one study, 161 patients with relapsed HL received autoSCT or chemotherapy only. More patients in the SCT group were still alive 3 years later without signs of cancer compared to the chemotherapy group (55% vs. 34%). However, not all patients are good candidates for SCT. For these patients, targeted therapy is often recommended.

For patients with refractory HL, targeted therapy can be effective. This type of treatment specifically targets cancer cells while leaving healthy cells alone. This can lead to fewer side effects. This therapy may also be recommended for patients who experience relapse after SCT. Brentuximab vedotin (Adcetris) is one such treatment. This agent binds to cancer cells and blocks their growth. In one study, patients received either brentuximab vedotin or a placebo (a substance with no active effect). More patients treated with brentuximab vedotin were still alive without tumor growth or spread 5 years later compared to the placebo group (59% vs. 41%).

Immunotherapy is another type of targeted therapy. This includes agents such as nivolumab (Opdivo) and pembrolizumab (Keytruda). These agents bind to cancer cells, marking them as targets for the body’s immune system. This leads to cancer cell death. In a study of 243 patients, 68% of patients responded to nivolumab. In another study, 70% of patients responded to pembrolizumab. 9 months after treatment, 63% of patients were still alive without tumor growth or spread.

Immunotherapy agents can also be combined. In one study, 62 patients received brentuximab vedotin and nivolumab. 80% of patients with refractory HL had a complete disappearance of all signs of cancer. For patients who had recurrent HL, this rate was 61%. Other immunotherapy combinations remain under investigation in clinical trials.

Elderly patients may not be able to tolerate high-dose chemotherapy and SCT. For these patients, targeted therapy or single-agent chemotherapy can be given. These patients should be monitored for side effects, such as low white blood cell count.

The bottom line

This article reviewed current treatment options for patients with relapsed or refractory HL.

Published By :

Hematological Oncology

Date :

Jun 01, 2019

Original Title :

Treating Hodgkin lymphoma in the new millennium: Relapsed and refractory disease.

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