What are the long-term outcomes for HL patients who experience treatment failure after an autologous stem cell transplant?

This study analyzed the survival outcomes of Hodgkin’s lymphoma (HL) patients who experience treatment failure after high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (autoSCT). This study concluded that a second stem cell transplant with or without brentuximab vedotin (Adcetris) may lead to better survival despite high risk factors.

High-dose chemotherapy (HDC) followed by autologous stem cell transplantation (autoSCT, using stem cells from the patient) is the current standard for relapsed or refractory (does not respond to treatment) Hodgkin’s lymphoma (HL). Auto-SCT is needed after chemotherapy to restore the hematopoietic (blood-forming) cells in the bone marrow.

8–75% of patients who undergo this treatment may experience treatment failure (refractory, progressive, or relapsed disease). 20–25% of these patients experience long-term survival, but the majority have limited treatment options due to rapidly progressing disease. Little data is available about the long-term outcomes of these patients, which remain under investigation.

This study involved 347 HL patients who received autoSCT. 83% of patients received ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy as a first-line treatment. 28.5% of patients received radiation after ABVD. 67% of patients had HDC and autoSCT for refractory disease. 98% of patients received BEAM (doxorubicin, bleomycin, vinblastine, dacarbazine) as HDC. The average follow-up period was 55.6 months.

39.5% of patients who received autoSCT experienced treatment failure. Of these, 46% were due to progressive disease, 35% were due to relapsed disease, and 19% were due to refractory disease. For these patients, the average overall survival (OS; death from any cause after post-SCT treatment failure) was 20 months. The average OS was 15 months (progressive disease), 21.8 months (relapsed disease), and 32.3 months (refractory disease). These rates were statistically significant.

75.9% of patients who experienced SCT failure received salvage treatment, including chemotherapy (39%), radiotherapy (35%), or supportive care (24%). 16.3% underwent a second SCT, with 17.3% receiving brentuximab vedotin. These SCT patients had a significantly improved OS of 50.6 months compared to the other treatments (22.5 months).

After salvage treatment, the overall response rate (cancer shrinks or disappears after treatment) was 45%. Of these, 30% of patients had complete remission (CR) and 15% of patients had partial remission (PR). The average OS for these patients was 30.5 months (PR), unreached (CR), and 9.4 months (progressive disease).

SCT failure within 1 year of treatment was associated with 3.37 times the risk of poor OS. Stage 3 or 4 disease was associated with 2.7 times increase in risk. These risk factors were all statistically significant.

This study concluded that a second stem cell transplant with or without brentuximab vedotin may lead to better survival despite high risk factors. The authors suggest that patients who experience treatment failure after HDC and autoSCT are perfect candidates for emerging new therapies in clinical trials.

This study only analyzed data from one center that uses certain practices. As a result, these results may not be reflected in other patient populations. Also, only 18 patients received brentuximab vedotin during the study due to its limited availability. Lastly, of the patients who received a second SCT, 88.2% received allogenic SCT (alloSCT). Because these patients need to be sensitive to chemotherapy and have an available donor, there is a clear selection bias.

If you have Hodgkin’s lymphoma and experienced treatment failure after autoSCT, discuss available treatment options with your care team.