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Tun AM, Wang Y, Matin A, Inwards DJ, Habermann TM, Micallef I, Johnston PB, Porrata L, Paludo J, Bisneto JV, Rosenthal A, Tun HW, Cerhan JR, Witzig TE, Nowakowski GS, Ansell SM. Outcomes of Patients With Classic Hodgkin Lymphoma Who Relapsed After Autologous Stem Cell Transplant. Hemasphere 2023; 7:e869. [PMID: 37034004 PMCID: PMC10079336 DOI: 10.1097/hs9.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/13/2023] [Indexed: 04/11/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) and brentuximab vedotin (BV) are novel agents for classic Hodgkin lymphoma, including relapse after autologous stem cell transplant (ASCT). However, their impact on survival post-ASCT relapse, in comparison with conventional therapy, is less known due to the lack of randomized controlled trials. Clinical characteristics and outcomes of 115 patients with relapse (or progression) after ASCT are studied. After a median follow-up of 8.59 years from post-ASCT relapse, the median progression-free survival (PFS) and overall survival (OS) were 0.91 and 5.07 years, respectively. Median lines of therapy after post-ASCT relapse was 2 (range, 1-12). The median PFS was not reached (NR) versus 1.11 versus 0.50 versus 0.85 versus 0.78 years (P = 0.006) and OS was NR versus 7.60 versus 3.08 versus 3.51 versus 3.17 years (P = 0.28) in patients first treated with ICIs versus BV versus investigational agents versus chemotherapy versus radiation therapy (RT). First-line treatment with novel agents (ie, ICIs and BV) was associated with superior outcomes compared with investigational agents and chemotherapy/RT with a median PFS of 1.65 versus 0.50 versus 0.79 years (P = 0.003) and a median OS of 7.60 versus 3.08 versus 3.32 years (P = 0.08). Regardless of lines of therapy, the treatment with ICIs had the most favorable outcome with a median PFS and OS of 3.98 and NR years, respectively. Allogeneic stem cell transplant (allo-SCT) was done in 23 patients (20%), and the median post-allo-SCT PFS and OS were 1.31 and 2.35 years, respectively. In conclusion, survival following post-ASCT relapse improves significantly when patients receive novel agents.
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Affiliation(s)
- Aung M. Tun
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Westwood, KS, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aasiya Matin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Luis Porrata
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Allison Rosenthal
- Internal Medicine, Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Han W. Tun
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL, USA
| | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Maaroufi M. Immunotherapy for Hodgkin lymphoma: From monoclonal antibodies to chimeric antigen receptor T-cell therapy. Crit Rev Oncol Hematol 2023; 182:103923. [PMID: 36702422 DOI: 10.1016/j.critrevonc.2023.103923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/11/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Although up to 80 % of Hodgkin lymphoma (HL) patients are cured with first-line therapy, relapsed/refractory HL remains a major clinical obstacle and is fatal for patients who are not candidates for autologous stem cell transplantation (ASCT) or relapse after treatment. Several immune-based approaches have been investigated in recent years with the aim of exerting a possible antitumor effect through the immune system response to cancer cells. Clinical studies on novel agents, including brentuximab vedotin (BV) and PD-1 inhibitors, have successfully demonstrated their effectiveness in relapsed disease after ASCT. Additionally, studies examining combination strategies with the goal of reducing the risk of relapse and chemotherapy-related toxicity have showed encouraging results, mainly in untreated early unfavorable or advanced stage classical HL (cHL). Other non-approved immunotherapies such as camidanlumab tesirine, bispecific CD30/CD16A antibody, and CD30 chimeric antigen receptor (CAR) T-cell therapy are promising approaches that may reinforce the therapeutic arsenal available to patients.
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Affiliation(s)
- Marouane Maaroufi
- Department of Medicine, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
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3
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Ferhanoglu B, Kim TM, Karduss A, Brittain D, Tumyan G, Al-Mansour M, Zerga M, Song Y, Rivas-Vera S, Kwong YL, Lim ST, Yeh SP, Abdillah A, Huang Z, Dalal M, Wan H, Hertzberg M. Treatment pathways and clinical outcomes in Hodgkin lymphoma outside Europe and North America: results from the international, multicenter, retrospective, B-HOLISTIC study. Leuk Lymphoma 2022; 63:3317-3330. [PMID: 36200380 DOI: 10.1080/10428194.2022.2126281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Information on Hodgkin lymphoma (HL) is mostly limited to Europe and North America. This real-world, retrospective study assessed treatment pathways and clinical outcomes in adults with stage IIB-IV classical HL receiving frontline treatment (n = 1598) or relapsed/refractory HL (RRHL, n = 426) in regions outside Europe and North America between January 2010 and December 2013. The primary endpoint was progression-free survival (PFS) in the RRHL group. Among patients with RRHL, 89.0% received salvage chemotherapy; most common regimen was etoposide, methylprednisolone, cytarabine, cisplatin (ESHAP; 26.3%). Median PFS in the RRHL group was 13.2 months (95% confidence interval [CI]: 9.9-20.2) and was longer in patients with vs. without stem cell transplantation (SCT; 20.6 vs. 7.5 months; p = 0.0071). This large-scale study identified a lower PFS for RRHL in the rest of the world compared with Europe and North America, highlighting the need for novel targeted therapies and SCT earlier in the treatment continuum.Clinical trial registration: NCT03327571.
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Affiliation(s)
- Burhan Ferhanoglu
- Division of Hematology, Department of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Amado Karduss
- Bone Marrow Transplant Program, Instituto de Cancerologia, Clínica las Américas, Medellín, Colombia
| | - David Brittain
- Albert Alberts Stem Cell Transplant Center, Pretoria East Hospital, Pretoria, South Africa
| | - Gayane Tumyan
- Department of Chemotherapy of Hemoblastosis, Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, The Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, The Kingdom of Saudi Arabia
| | - Marta Zerga
- Department of Hematology, Angel Roffo Institute, Buenos Aires, Argentina
| | - Yuqin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing, China
| | - Silvia Rivas-Vera
- Department of Hematology, Instituto Nacional de Cancerologia Mexico, Mexico City, Mexico
| | - Yok Lam Kwong
- Bone Marrow Transplant Unit, Queen Mary Hospital, Hong Kong, China.,Hematology Division, Medical Oncology and Bone Marrow Transplantation, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Su-Peng Yeh
- Division of Hematology and Oncology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Arif Abdillah
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore, Singapore
| | - Zhongwen Huang
- Takeda R&D Data Sciences Institute, Takeda Development Center Americas, Inc. (TDCA), Lexington, MA, USA
| | - Mehul Dalal
- Takeda R&D Data Sciences Institute, Takeda Development Center Americas, Inc. (TDCA), Lexington, MA, USA
| | - Hui Wan
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore, Singapore
| | - Mark Hertzberg
- Department of Clinical Haematology, Prince of Wales Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
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De Filippi R, Marcacci G, Derenzini E, Musso M, Donnarumma D, Morelli E, Patti C, Maraglino AME, Scalone R, Simeone L, Becchimanzi C, Mele S, Crisci S, Morabito F, Pinto A. Anti-PD1 Consolidation in Patients with Hodgkin Lymphoma at High Risk of Relapse after Autologous Stem Cell Transplantation: A Multicenter Real-Life Study. Cancers (Basel) 2022; 14:5846. [PMID: 36497328 PMCID: PMC9739754 DOI: 10.3390/cancers14235846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Consolidation therapy is an emerging strategy for patients with relapsed/refractory (RR) Hodgkin Lymphoma (HL) at high risk of failing salvage autologous stem cell transplantation (ASCT). (2) Objectives: To assess the safety and effectiveness of PD1-blockade consolidation for these high-risk patients. (3) Design: Multi-center retrospective analysis. (4) Methods: We identified 26 patients given anti-PD1 consolidation, from June 2016 to May 2020. (5) Results: Patients displayed the following risk factors: refractory disease (69%), relapse < 12 months from upfront therapy (15%), ≥2 lines of salvage therapy (73%), extranodal disease (65%). Nineteen patients (73%) had ≥3 of these factors. In addition, 16 patients (61%) also displayed PET-positive (Deauville ≥ 4) disease before ASCT. Treatment-related adverse events (TRAEs), never graded > 3, occurred in 12 patients (46.15%) and mainly included skin rashes (41.7%), transaminitis (33.3%), and thyroid hypofunction (25%). Patients completed a median of 13 courses (range 6−30). At a median follow-up of 25.8 months post-ASCT, the median progression-free (PFS) was 42.6 months, with a 2-year PFS and overall survival rates of 79% and 87%, respectively. (6) Conclusions: Post-ASCT consolidation with anti-PD1 is feasible and effective. Further studies are warranted to define the optimal treatment length and patients’ subsets more likely to benefit from this approach.
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Affiliation(s)
- Rosaria De Filippi
- Department of Clinical Medicine and Surgery, Università degli Studi Federico II, 80131 Naples, Italy
| | - Gianpaolo Marcacci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Enrico Derenzini
- Oncohematology Division, IEO European Institute of Oncology IRCCS, Department of Health Sciences, University of Milan, 20129 Milan, Italy
| | - Maurizio Musso
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, 90145 Palermo, Italy
| | - Daniela Donnarumma
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Emanuela Morelli
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Caterina Patti
- Division of Onco-Hematology, Azienda Villa Sofia-Cervello, 90146 Palermo, Italy
| | - Alessio Maria Edoardo Maraglino
- Oncohematology Division, IEO European Institute of Oncology IRCCS, Department of Health Sciences, University of Milan, 20129 Milan, Italy
| | - Renato Scalone
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, 90145 Palermo, Italy
| | - Luigia Simeone
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Cristina Becchimanzi
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Sara Mele
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Fortunato Morabito
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, IRCCS, 80131 Naples, Italy
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Nisbett AR, Yang X, Squires P, Gautam S, Desai K, Raut M, Nahar A. Treatment patterns and clinical outcomes among patients with relapsed/refractory classical Hodgkin's lymphoma. Future Oncol 2022; 18:3623-3636. [PMID: 36200907 DOI: 10.2217/fon-2022-0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Limited real-world data exist on treatment patterns and clinical outcomes for patients with relapsed/refractory (R/R) classical Hodgkin's lymphoma (cHL). Methods: This study used the ConcertAI Oncology Dataset to assess treatment patterns, real-world progression-free survival (rwPFS), and real-world overall survival (rwOS) in adults with R/R cHL diagnosed from 2000 to 2019. Results: Among 226 (79%) treated patients, there was substantial treatment heterogeneity. Median rwPFS was 21.0 months in the second line (2L) of therapy. Median rwOS was 146.7 months in 2L and decreased to 40.6 months in the fifth line. Conclusion: Patients were exposed to a myriad of treatments in the R/R setting. These data support a relation between rwPFS and rwOS and highlight the need for effective therapeutic options.
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Affiliation(s)
| | - Xiaoqin Yang
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Patrick Squires
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Santosh Gautam
- ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - Kaushal Desai
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Monika Raut
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
| | - Akash Nahar
- Merck & Co., Inc., 2000 Galloping Hill Rd, Kenilworth, NJ 07033, USA
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6
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Halahleh K, Al Sawajneh S, Saleh Y, Shahin O, Abufara A, Ma'koseh M, Abdel-Razeq R, Barakat F, Abdelkhaleq H, Al-Hassan N, Atiyyat R, Al-Faker N, Omari Z, Ghatasheh H, Jaradat I, Muradi I, Iyad S, Bazarbachi A. Pembrolizumab for the Treatment of Relapsed and Refractory Classical Hodgkin Lymphoma After Autologous Transplant and in Transplant-Naïve Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:589-595. [PMID: 35490153 DOI: 10.1016/j.clml.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Checkpoint inhibitors demonstrated significant efficacy in relapsed/refractory Hodgkin's Lymphoma (R/R cHL) resulting in high responses and prolonged progression free survival in patients, who relapse after or are ineligible for autologous stem cell transplantation (auto-SCT). We aimed to assess the efficacy and toxicity of Pembrolizumab before auto-SCT and in transplant naïve patients and calculate survival outcomes. PATIENTS AND METHODS Fifty-five patients with R/R cHL were included. Patients demographics, including age, sex, risk stratification, therapy received and details pertaining transplantation, were collected. RESULTS Median age was 28 years (range, 16-62 years). The median follow-up was 15.3 months and the median number of previous treatments was 3 (1-10). The best objective response was 74.5% (CR 32.7%, SD 5.5%) with reasonable safety profile. Twenty-nine of the responding patients received subsequent auto-SCT and 9 allogeneic stem cell transplantation (allo-SCT), 6 are currently alive with ongoing response. At the time of analysis, 6 patients remained on Pembrolizumab and the rest discontinued. The main reason for discontinuation was disease progression (n-49). Twelve-months overall survival and progression free survival (PFS) was 92% (95% CI: 76%-95%) and 51% (95% CI, 39%-67%) respectively. Twelve-month PFS for patients, who achieved CR or PR or PD was 88% (95% CI: 07%-75%); PR 60% (95% CI: 21%-29%) and 5% (95% CI: 5%-0%). Though the number of patients who received auto-SCT after Pembrolizumab was small (n-15), 12 months overall survival and PFS 100% and PFS 92%. 11 patients (20%) deceased during the follow-up and none was regarded to be treatment-related. CONCLUSION Checkpoint inhibitors are effective in heavily pretreated cHL patients with reasonable survival outcomes. The results supporting the concept of auto and/or allo-SCT after checkpoint inhibitors use.
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Affiliation(s)
- Khalid Halahleh
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan.
| | - Suhaib Al Sawajneh
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Yacob Saleh
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Omar Shahin
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Mohamad Ma'koseh
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Rashid Abdel-Razeq
- Department of Medical Oncology-Hematology, Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Fareed Barakat
- Department of Hematopathology, King Hussein Cancer Center, Amman, Jordan
| | - Hadeel Abdelkhaleq
- Biostatistics Unit, Research Office, King Hussein Cancer Center, Amman, Jordan
| | - Nadira Al-Hassan
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Reem Atiyyat
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Noor Al-Faker
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Zaid Omari
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Hamza Ghatasheh
- Department of Radiotherapy, King Hussein Cancer Center, Amman, Jordan
| | - Imad Jaradat
- Department of Radiotherapy, King Hussein Cancer Center, Amman, Jordan
| | - Isa Muradi
- Department of Medicine, University of Tripoli, Tripoli, Libya
| | - Sultan Iyad
- Department of Pediatrics, Medical Oncology-Hematology, King Hussein Cancer Center, Amman, Jordan
| | - Ali Bazarbachi
- Bone Marrow Transplantation Department, American University of Beirut, Beirut, Lebanon
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7
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Radhakrishnan VS, Bajaj R, Raina V, Kumar J, Bhave SJ, Sukumaran Nair RK, Nag A, Arun I, Zameer L, Dey D, Arora N, Parihar M, Das J, Achari RB, Mishra DK, Chandy M, Nair R. Relapsed Refractory Hodgkin Lymphoma and Brentuximab Vedotin-Bendamustine Combination Therapy as a Bridge to Transplantation: Real-World Evidence From a Middle-Income Setting and Literature Review. Front Oncol 2022; 11:796270. [PMID: 35127505 PMCID: PMC8814627 DOI: 10.3389/fonc.2021.796270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Despite high cure rates with standard treatment, 30% patients with Hodgkin lymphoma develop relapsed or refractory (R/R) disease. Salvage therapy followed by autologous hematopoietic cell transplantation (HCT) is considered standard of care. Brentuximab Vedotin (Bv) in combination with Bendamustine (B) has been tested in the salvage setting with promising results. Materials and Methodology We conducted a single centre retrospective chart review of patients who received BBv salvage therapy to determine its activity and safety in patients with R/R classical Hodgkin lymphoma (HL). Between May 2011- December 2019, 179 patients were diagnosed with R/R HL. Results Thirty patients received BBv [median age: 30 (15-59) years, females (n=15)]. Primary refractory disease in 19 patients (63%), and 26 patients (87%) had advanced stage at treatment. Most patients received BBv after 2 prior lines of therapy [n=16 (53%)]. The median number of cycles of BBv were 3 (1-6). The number of BBv cycles delivered as outpatient was 63%. The most common Grade III/IV hematological adverse event was neutropenia [n=21, (70%)], while grade III/IV non-hematological toxicities included infections in 4 (13%), neuropathy in 4(13%), skin rash in 2 (7%), GI toxicities in 3 (10%) and liver dysfunction in 2 (7%) patients. The ORR and CR rates were 79% and 62%, respectively. Seventeen patients (57%) underwent an autologous HCT and 8 (26%) underwent an Allogeneic HCT (all haploidentical). The median follow up time from BBv administration was 12 months. Six patients died: 2 = disease progression, and 4 = non-relapse causes (Infection and sepsis = 2, GVHD=2). In addition to this, one patient progressed soon after HCT and another patient relapsed 22 months post HCT. Three year Overall survival (OS) and Event free survival (EFS) probability post-BBv treatment was 75% and 58%, respectively. OS and EFS analysis based on response (viz., CMR) to BBv demonstrated that patients in CMR had better survival probability [93% (p=0.0022) 3yr-OS and 72% (p=0.038) 3yr-EFS probability]. Conclusions BBv is an active and well-tolerated salvage treatment for patients with R/R HL, even in refractory and advanced settings. In middle-income settings, cost constraints and access determine patient uptake of this regimen.
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Affiliation(s)
- Vivek S. Radhakrishnan
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
- *Correspondence: Vivek S. Radhakrishnan, ; orcid.org/0000-0001-9484-5669
| | - Rajat Bajaj
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Vasundhara Raina
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Jeevan Kumar
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Saurabh J. Bhave
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | | | - Arijit Nag
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Indu Arun
- Histopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Histopathology, Tata Medical Center, Kolkata, India
| | - Neeraj Arora
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Mayur Parihar
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Jayanta Das
- Nuclear Medicine, Tata Medical Center, Kolkata, India
| | | | - Deepak K. Mishra
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Mammen Chandy
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Reena Nair
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
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8
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Veilleux O, Claveau JS, Alaoui H, Roy J, Ahmad I, Delisle JS, Kiss T, Bambace NM, Bernard L, Cohen S, Sauvageau G, Fleury I, Mollica L, Roy DC, Seroukh Y, Lachance S. Real-world outcomes of autologous and allogeneic hematopoietic stem cell transplantation for relapsed/refractory Hodgkin lymphoma in the era of novel therapies: a Canadian perspective. Transplant Cell Ther 2021; 28:145-151. [PMID: 34954149 DOI: 10.1016/j.jtct.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high cure rates with frontline therapy for Hodgkin lymphoma (HL), about 30% of patients will relapse or have primary refractory disease (R/r). Autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care for R/r disease and alloHSCT is a curative option for patients in second relapse. Novel agents are being incorporated for the treatment of R/r HL, such that the optimal timing of transplant is currently being challenged. Additionally, because access to these new agents varies amongst transplant centers, we sought to offer a Canadian perspective to the treatment of R/r HL and demonstrate the utility and effectiveness of both AHSCT and alloHSCT for the treatment of R/r HL. METHODS This single-center retrospective study examined outcomes in 89 consecutive patients with R/r HL treated with AHSCT between January 2007 and December 2019. A total of 17 patients underwent alloHSCT either as a tandem auto-allo approach or as salvage therapy. RESULTS With a median follow-up of 5.0 years, the estimated 5-year PFS and OS for patients undergoing AHSCT were 57.5% (95% CI 45.2-68.0) and 81.3% (95% CI 70.0-88.8), respectively. Corresponding figures for patients who underwent alloHSCT were 76.5% (95% CI 48.8-90.4) and 82.4% (95% CI 54.7-93.9). NRM at 100 days and 5 years was 0% and 9.4% post AHSCT and 0% and 5.9% post alloHSCT. Cumulative incidence (CI) of acute GVHD at day +100 was 35.3% (95% CI 17.7 - 62.3) and CI of chronic GVHD at 1 year was 23.5% (95% CI 6.9 - 45.8). CONCLUSIONS AHSCT and alloHSCT can both provide robust and prolonged disease control and new agents should be used as a bridge to improve the curative potential of these definitive cellular therapies.
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Affiliation(s)
- Olivier Veilleux
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Claveau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Habiba Alaoui
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Imran Ahmad
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Delisle
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Thomas Kiss
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Nadia M Bambace
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Léa Bernard
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sandra Cohen
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Guy Sauvageau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Fleury
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Luigina Mollica
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Denis-Claude Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Yasmina Seroukh
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Lachance
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
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9
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Shah H, Jang H, Singh P, Kosti J, Kin A, Alavi A, Ratanatharathorn V, Ayash L, Uberti J, Ramchandren R, Kim S, Deol A. Improved post-ASCT survival of relapsed/refractory classical Hodgkin lymphoma patients in the era of novel agents. Leuk Lymphoma 2021; 63:813-820. [PMID: 34781825 DOI: 10.1080/10428194.2021.2002322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Utilization of novel agents such as brentuximab vedotin (BV) and check-point inhibitors (CI) has increased in patients with relapsed/refractory (r/r) classical Hodgkin Lymphoma (cHL). We conducted a retrospective study of 209 patients who had ASCT for r/r cHL at our institution and compared outcomes of those who had ASCT from 2010-2018 (cohort 2, n = 110) with those who had ASCT between 2000 and 2009 (cohort 1, n = 99). The median OS was 7.6 years for cohort 1 [HR 2.08; 95% CI 1.14-3.80; p = 0.017] and not reached for cohort 2; with 4-year improved OS difference of 15% (80% vs 65%) in cohort 2 vs cohort 1. The median PFS of cohort 1 was 30 months vs 39 months for cohort 2[HR 1.24; 95% CI 0.82-1.88; p = 0.3]. This study highlights improved OS of r/r cHL patients who have received ASCT in the novel agent era due to the exposure to agents such as BV and CIs.
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Affiliation(s)
- Harsh Shah
- Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA
| | - Hyejeong Jang
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Paramveer Singh
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Jorgena Kosti
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Andrew Kin
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Asif Alavi
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | - Lois Ayash
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Joseph Uberti
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | - Seongho Kim
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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10
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Uncu Ulu B, Dal MS, Yönal Hindilerden İ, Akay OM, Mehtap Ö, Büyükkurt N, Hindilerden F, Güneş AK, Yiğenoğlu TN, Başcı S, Kızıl Çakar M, Yanardağ Açık D, Korkmaz S, Ulaş T, Özet G, Ferhanoğlu B, Nalçacı M, Altuntaş F. Brentuximab vedotin and bendamustine: an effective salvage therapy for relapsed or refractory Hodgkin lymphoma patients. J Chemother 2021; 34:190-198. [PMID: 34514960 DOI: 10.1080/1120009x.2021.1976912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prognosis is poor for relapsed or refractory (R/R) classical Hodgkin Lymphoma (cHL) patients. The brentuximab vedotin (Bv) and bendamustine (B) combination has been used as a preferable salvage regimen in R/R cHL patient trials. We retrospectively evaluated response rates, toxicities, and the survival in R/R cHL patients treated with the BvB combination. In a multi-centre real-life study, 61 R/R HL patients received intravenous doses of 1.8 mg/kg Bv on the first day plus 90 mg/m2 B on the first and second days of a 21-day cycle as a second-line or beyond-salvage regimen. Patients' median age at BvB initiation was 33 (range: 18-76 years). BvB was given as median third-line treatment for a median of four cycles (range: 2-11). The overall and complete response rates were 82% and 68.9%, respectively. After BvB initiation, the median follow-up was 14 months, and one- and two-year overall survival rates were 85% and 72%, respectively. Grade 3/4 toxicities included neutropenia (24.6%), lymphopenia (40%), thrombocytopenia (13%), anaemia (13%), infusion reactions (8.2%), neuropathy (6.5%), and others. The BvB combination could be given as salvage regimen aiming a bridge to autologous stem cell transplant (ASCT), in patients relapse after ASCT or to transplant-ineligible patients with manageable toxicity profiles.
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Affiliation(s)
- Bahar Uncu Ulu
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - İpek Yönal Hindilerden
- Faculty of Medicine, Internal Medicine Department, Division of Hematology, Istanbul University, Istanbul, Turkey
| | - Olga Meltem Akay
- School of Medicine, Department of Hematology, Koç University, İstanbul, Turkey
| | - Özgür Mehtap
- Faculty of Medicine, Department of Hematology, Kocaeli University, Kocaeli, Turkey
| | - Nurhilal Büyükkurt
- Department of Hematology, Baskent University School of Medicine, Adana Research and Training Hospital, Adana, Turkey
| | - Fehmi Hindilerden
- University of Health Sciences, Bakirköy Dr. Sadi Konuk Training and Research Hospital Hematology Clinic, Istanbul, Turkey
| | - Ahmet Kürşad Güneş
- Department of Hematology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Semih Başcı
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Didar Yanardağ Açık
- Department of Internal Medicine and Hematology, Adana City Education and Research Hospital, Adana, Turkey
| | - Serdal Korkmaz
- Department of Hematology, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Turgay Ulaş
- School of Medicine, Department of Internal Medicine, Division of Hematology, Near East University, Nicosia, Cyprus
| | - Gülsüm Özet
- Department of Hematology and Bone Marrow Transplantation, Ankara City Hospital, Ankara, Turkey
| | - Burhan Ferhanoğlu
- Department of Hematology and Oncology, VKV American Hospital, Istanbul, Turkey
| | - Meliha Nalçacı
- Faculty of Medicine, Internal Medicine Department, Division of Hematology, Istanbul University, Istanbul, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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11
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Lapierre L, Pericart S, Protin C, Borel C, Ysebaert L, Laurent C, Oberic L. Nivolumab in refractory cerebral relapse of Hodgkin's lymphoma. Leuk Lymphoma 2021; 62:3063-3065. [PMID: 34254883 DOI: 10.1080/10428194.2021.1950711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Leopoldine Lapierre
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Sarah Pericart
- Department of Pathology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Caroline Protin
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Cecile Borel
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Loic Ysebaert
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
| | - Lucie Oberic
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, France
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12
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A phase 1b study of AFM13 in combination with pembrolizumab in patients with relapsed or refractory Hodgkin lymphoma. Blood 2021; 136:2401-2409. [PMID: 32730586 DOI: 10.1182/blood.2019004701] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/01/2020] [Indexed: 12/26/2022] Open
Abstract
In relapsed/refractory Hodgkin lymphoma (R/R HL), immunotherapies such as the anti-programmed death-1 inhibitor pembrolizumab have demonstrated efficacy as monotherapy and are playing an increasingly prominent role in treatment. The CD30/CD16A-bispecific antibody AFM13 is an innate immune cell engager, a first-in-class, tetravalent antibody, designed to create a bridge between CD30 on HL cells and the CD16A receptor on natural killer cells and macrophages, to induce tumor cell killing. Early studies of AFM13 have demonstrated signs of efficacy as monotherapy for patients with R/R HL and the combination of AFM13 with pembrolizumab represents a rational new treatment modality. Here, we describe a phase 1b, dose-escalation study to assess the safety and preliminary efficacy of AFM13 in combination with pembrolizumab in patients with R/R HL. The primary objective was estimating the maximum tolerated dose; the secondary objectives were to assess safety, tolerability, antitumor efficacy, pharmacokinetics, and pharmacodynamics. In this heavily pretreated patient population, treatment with the combination of AFM13 and pembrolizumab was generally well tolerated, with similar safety profiles compared to the known profiles of each agent alone. The combination of AFM13 with pembrolizumab demonstrated an objective response rate of 88% at the highest treatment dose, with an 83% overall response rate for the overall population. Pharmacokinetic assessment of AFM13 in the combination setting revealed a half-life of up to 20.6 hours. This proof-of-concept study holds promise as a novel immunotherapy combination worthy of further investigation. This phase 1b study was registered at www.clinicaltrials.gov as NCT02665650.
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13
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Voorhees TJ, Beaven AW. Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma. Cancers (Basel) 2020; 12:E2887. [PMID: 33050054 PMCID: PMC7601361 DOI: 10.3390/cancers12102887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is a B-cell malignancy representing approximately one in ten lymphomas diagnosed in the United States annually. The majority of patients with HL can be cured with chemotherapy; however, 5-10% will have refractory disease to front-line therapy and 10-30% will relapse. For those with relapsed or refractory (r/r) HL, salvage chemotherapy followed by autologous stem cell transplant (ASCT) is standard of care, but half of patients will subsequently have disease progression. Relapse following ASCT has been associated with exceedingly poor prognosis with a median survival of only 26 months. However, in recent years, novel agents including brentuximab vedotin (BV) and programmed cell death protein 1 monoclonal antibodies (anti-PD-1, nivolumab and pembrolizumab) have been shown to extend overall survival in r/r HL. With the success of novel agents in relapsed disease after ASCT, these therapies are beginning to show clinically meaningful response rates prior to ASCT. Finally, a new investigation in r/r HL continues to produce promising treatment options even after ASCT including CD30 directed chimeric antigen receptor T-cell therapy. In this review, we will discuss the recent advances of BV and anti-PD-1 therapy prior to ASCT, novel approaches in r/r HL after ASCT, and review active clinical trials.
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Affiliation(s)
| | - Anne W Beaven
- Department of Internal Medicine, Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA;
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14
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Diefenbach CS, Hong F, Ambinder RF, Cohen JB, Robertson MJ, David KA, Advani RH, Fenske TS, Barta SK, Palmisiano ND, Svoboda J, Morgan DS, Karmali R, Sharon E, Streicher H, Kahl BS, Ansell SM. Ipilimumab, nivolumab, and brentuximab vedotin combination therapies in patients with relapsed or refractory Hodgkin lymphoma: phase 1 results of an open-label, multicentre, phase 1/2 trial. LANCET HAEMATOLOGY 2020; 7:e660-e670. [PMID: 32853585 DOI: 10.1016/s2352-3026(20)30221-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recognising that the immune suppressive microenvironment promotes tumour growth in Hodgkin lymphoma, we hypothesised that activating immunity might augment the activity of targeted chemotherapy. We evaluated the safety and activity of combinations of brentuximab vedotin with nivolumab or ipilimumab, or both in patients with relapsed or refractory Hodgkin lymphoma. METHODS In this multicentre, open-label, phase 1/2 trial, patients with relapsed or refractory Hodgkin lymphoma aged 18 years or older who had relapsed after at least one line of therapy, with an Eastern Cooperative Oncology Group performance status of 2 or lower, and adequate organ and marrow function, with no pulmonary dysfunction were eligible for inclusion. Phase 1 primary objectives were to determine the maximum tolerated dose and dose limiting toxicities of brentuximab vedotin combined with ipilimumab (ipilimumab group), nivolumab (nivolumab group), or both (triplet therapy group) using a 3 + 3 dose escalation design with expansion cohorts. During the dose escalation phase, patients were enrolled sequentially into one of six cohorts: in the ipilimumab group fixed brentuximab vedotin 1·8 mg/kg with ipilimumab 1 mg/kg (cohort A) or 3 mg/kg (cohort B); in the nivolumab group fixed nivolumab 3 mg/kg with brentuximab vedotin 1·2 mg/kg (cohort D) or 1·8 mg/kg (cohort E); and in the triplet therapy group fixed nivolumab 3 mg/kg and ipilimumab 1 mg/kg with brentuximab vedotin 1·2 mg/kg (cohort G) or 1·8 mg/kg (cohort H). Additional patients were enrolled in the expansion phase at the same doses of cohorts B, E, and H. All drugs were given intravenously; brentuximab vedotin and nivolumab were given every 3 weeks, ipilimumab was given every 6 weeks in the ipilimumab group and every 12 weeks in the triplet therapy group. All eligible and treated patients were included in the analysis. This phase 1/2 study is registered with ClinicalTrials.gov, NCT01896999. The phase 2, randomised portion of the trial is still enrolling. FINDINGS Between March 7, 2014, and Dec 28, 2017, 64 patients were enrolled; two patients in the ipilimumab group and one patient in the nivolumab group were excluded due to ineligibility after enrolment and 61 were evaluable. A total of six dose limiting toxicities were reported in four patients, and the doses used in cohorts B, E, and H were established as maximum tolerated doses and patients were subsequently enrolled onto expansion cohorts (C, F, and I) with these schedules. There were ten (43%) grade 3-4 treatment related adverse events in the ipilimumab group, three (16%) in the nivolumab group, and 11 (50%) in the triplet therapy group including: eight (13%) of 64 patients reporting rash, and colitis, gastritis, pancreatitis and arthritis, and diabetic ketoacidosis each occurring in one (2%) patient. There were two (3%) treatment related deaths, one in the nivolumab group and one in the triplet therapy group. The overall response rate was 76% (95% CI 53-92) in the ipilimumab group, 89% (65-99) in the nivolumab group, and 82% (60-95) in the triplet therapy group, and the complete response rate was 57% (95% CI 34-78%) in the ipilimumab group, 61% (36-83%) in the nivolumab group, and 73% (50-89%) in the triplet therapy group. With a median follow-up of 2·6 years (IQR 1·8-2·9) in the ipilimumab group, 2·4 years (2·2-2·6) in the nivolumab group, and 1·7 years (1·6-1·9) in the triplet therapy group, median progression-free survival is 1·2 years (95% CI 1·7-not reached) in the ipilimumab group, but was not reached in the other two treatment groups. Median overall survival has not been reached in any of the groups. INTERPRETATION There are clear differences in activity and toxicity of the three combination regimens. The tolerability and preliminary activity for the two most active regimens, brentuximab vedotin with nivolumab and the triplet therapy, are being compared in a randomised phase 2 trial (NCT01896999). FUNDING Eastern Cooperative Oncology Group-American College of Radiology Imaging Network and the National Cancer Institute of the National Institutes of Health.
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Affiliation(s)
| | - Fangxin Hong
- Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Biostatistics Center, Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Jersey, NJ, USA
| | | | - Timothy S Fenske
- Division of Hematology and Oncology, Froedtert and the Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Stefan K Barta
- Divison of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil D Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Morgan
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reem Karmali
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, USA
| | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethseda, MD, USA
| | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethseda, MD, USA
| | - Brad S Kahl
- School of Medicine, Washington University, St Louis, MO, USA
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15
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Sawas A, Ma H, Kuruvilla J, Lue JK, Deng C, Marchi E, Montanari F, Cheng B, Savage KJ, Villa D, Crump M, Connors JM, O'Connor OA. Prolonged progression free survival in a subset of responders to the combination of brentuximab vedotin and bendamustine in heavily treated patients with relapsed or refractory Hodgkin lymphoma: updated results from an international multi-center phase I/II experience. Leuk Lymphoma 2020; 61:3014-3017. [PMID: 32720828 DOI: 10.1080/10428194.2020.1795161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Ahmed Sawas
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Helen Ma
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer K Lue
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Changchun Deng
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Enrica Marchi
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Francesca Montanari
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Bin Cheng
- Center for Lymphoid Malignancies, Columbia University Irving Medical Center, New York, NY, USA
| | - Kerry J Savage
- BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Diego Villa
- BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Owen A O'Connor
- Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA
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16
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Iqbal M, Kharfan-Dabaja MA. Relapse of Hodgkin lymphoma after autologous hematopoietic cell transplantation: A current management perspective. Hematol Oncol Stem Cell Ther 2020; 14:95-103. [PMID: 32603659 DOI: 10.1016/j.hemonc.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is a highly responsive disease with nearly 70% of patients experiencing cure after front-line chemotherapy. Patients who experience disease relapse receive salvage chemotherapy followed by consolidation with autologous hematopoietic cell transplantation (auto-HCT). Nearly 50% of patients relapse after an auto-HCT and constitute a subgroup with poor prognosis. Novel treatments such as immune checkpoint inhibitors and an anti-CD30 monoclonal antibody are currently approved for patients relapsing after auto-HCT; however, the duration of remission with these therapies remains limited. Allogeneic HCT is currently the only potentially curative treatment modality for patients relapsing after a prior auto-HCT. Early clinical trials with chimeric antigen receptor T-cell therapy targeting CD30 are underway for patients with relapsed/refractory HL and are already demonstrating safety and promising efficacy.
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Affiliation(s)
- Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA.
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17
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Bekoz H, Ozbalak M, Karadurmus N, Paydas S, Turker A, Toptas T, Tuglular TF, Altuntas F, Cakar MK, Sonmez M, Gulbas Z, Demir N, Kaynar L, Yildirim R, Karadogan I, Arat M, Kapucu I, Aslan NA, Ozkocaman V, Turgut M, Yuksel MK, Ozcan M, Hacioglu SK, Barista I, Demirkaya M, Saydam G, Toprak SK, Yilmaz M, Demirkol O, Ferhanoglu B. Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience. Ann Hematol 2020; 99:2565-2576. [DOI: 10.1007/s00277-020-04077-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 05/04/2020] [Indexed: 01/01/2023]
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18
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Di Renzo N, Gaudio F, Carlo Stella C, Oppi S, Pelosini M, Sorasio R, Stelitano C, Rigacci L. Relapsing/refractory HL after autotransplantation: which treatment? ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:30-40. [PMID: 32525132 PMCID: PMC7944654 DOI: 10.23750/abm.v91is-5.9912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022]
Abstract
For advanced-stage Hodgkin lymphoma (HL), front-line chemotherapy, alone or in combination with radiotherapy, leads to 5-year progression-free survival (PFS) rates and freedom-from-treatment failure (FFTF) rates of 70-85%, regardless of the chemotherapy regimen applied. Patients with HL experiencing disease progression during or within 3 months of front-line therapy (primary refractory) and patients whose disease relapses after a complete response have a second chance of treatment. The standard of care for relapsed or refractory HL is second-line chemotherapy followed by autologous stem cell transplantation (ASCT), which can induce long-term remission in approximately 40-50% of patients. However, HL recurrence occurs in about 50% of patients after ASCT, usually within the first year, and represents a significant therapeutic challenge. Allogeneic transplantation from HLA-matched donors represents the standard of care for patients with HL relapsing after- or refractory to ASCT.
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Affiliation(s)
- Nicola Di Renzo
- Department of Hematology and Stem Cell Transplant, Presidio Ospedaliero Vito Fazzi, Lecce, Italy.
| | - Francesco Gaudio
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Italy.
| | - Carmelo Carlo Stella
- Department of Hematology and Oncology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy.
| | - Sara Oppi
- Bone Marrow Transplant Center, R. Binaghi Hospital, ASL 8, Cagliari, Italy.
| | | | - Roberto Sorasio
- Division of Hematology, A.O. Santi Croce e Carle, Cuneo, Italy.
| | - Caterina Stelitano
- Division of Hematology, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria, Italy.
| | - Luigi Rigacci
- Haematology Unit and Bone Marrow Transplant Unit, San Camillo Forlanini Hospital, Rome, Italy.
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019; 11:E1071. [PMID: 31362369 PMCID: PMC6721364 DOI: 10.3390/cancers11081071] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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21
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019. [PMID: 31362369 DOI: 10.3390/cancers] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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22
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Moskowitz AJ, Herrera AF, Beaven AW. Relapsed and Refractory Classical Hodgkin Lymphoma: Keeping Pace With Novel Agents and New Options for Salvage Therapy. Am Soc Clin Oncol Educ Book 2019; 39:477-486. [PMID: 31099645 DOI: 10.1200/edbk_238799] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The management of relapsed and refractory classic Hodgkin lymphoma (HL) has changed substantially since the approval of brentuximab vedotin (BV) and the checkpoint inhibitors nivolumab and pembrolizumab. For patients progressing after frontline treatment, second-line therapy followed by consolidation with autologous stem cell transplant (ASCT) remains the standard of care; however, although traditional combination chemotherapy regimens previously represented the only options for salvage, BV is now routinely incorporated into second-line therapy, and studies are evaluating checkpoint inhibitors in this setting as well. After ASCT, BV maintenance improves progression-free survival for patients at higher-risk, and studies are evaluating the role of post-ASCT maintenance with checkpoint inhibitors. Management of HL that progresses after ASCT remains a challenge. Although many patients achieve prolonged disease control with checkpoint inhibitors, the majority eventually progress and require additional therapy. Newer approaches, including CD30-directed chimeric antigen receptor-T-cell therapy, appear promising. Furthermore, allogeneic stem cell transplant remains an important consideration. Altogether, BV and checkpoint inhibitors have improved survival for patients with relapsed and refractory HL. However, the ideal place for these drugs in the treatment course of HL is still under investigation. Ongoing studies testing novel combinations and assessing for prognostic and predictive markers will ultimately define the optimal setting for these drugs in the treatment of relapsed and refractory HL.
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Affiliation(s)
| | | | - Anne W Beaven
- 3 Lineberger Comprehensive Cancer Center, University of North Carolina - Chapel Hill, Chapel Hill, NC
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23
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Bair SM, Strelec LE, Feldman TA, Ahmed G, Armand P, Shah NN, Singavi AN, Reddy N, Khan N, Andreadis C, Vu K, Huntington SF, Giri S, Ujjani C, Howlett C, Faheem M, Youngman MR, Nasta SD, Landsburg DJ, Schuster SJ, Svoboda J. Outcomes and Toxicities of Programmed Death-1 (PD-1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Real-World, Multicenter Retrospective Analysis. Oncologist 2018; 24:955-962. [PMID: 30568021 DOI: 10.1634/theoncologist.2018-0538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although classical Hodgkin lymphoma (cHL) is highly curable, 20%-30% of patients will not be cured with conventional treatments. The programmed death-1 (PD-1) inhibitors (PD-1i) nivolumab and pembrolizumab have been Food and Drug Administration-approved for relapsed/refractory (R/R) cHL. There is limited data on the real-world experience with PD-1i in cHL and it is unknown whether fewer selected patients treated with PD-1i derive benefits similar to those observed in published trials. MATERIALS AND METHODS We performed a multicenter, retrospective analysis of R/R cHL patients treated with PD-1i in the nontrial setting. The primary objective was to describe progression-free survival (PFS) and overall survival (OS) in this population. Secondary objectives were to characterize response rates, toxicities, discontinuation patterns, and post-PD-1i therapies. RESULTS The study included 53 patients from nine U.S. centers. Overall response rate (ORR), complete response (CR), and partial response (PR) to PD-1i were 68%, 45%, and 23%, respectively. Twelve-month OS and PFS were 89% and 75%, respectively; median PFS was 29 months. Ninety-six percent of patients with CR continue to respond at a median follow-up of 20 months. Toxicities were similar to those previously described. Seventy percent of patients treated with systemic therapy after PD-1i demonstrated objective responses. CONCLUSION To our knowledge, this analysis is the first describing real-world experience with PD-1i in cHL patients in the U.S. Here, we demonstrate similar response rates compared to prior studies. The toxicity profile of PD-1i was similar to that seen in previous studies; we further describe toxicity patterns in those with prior autoimmune disease or allogeneic transplant. Post-PD-1i systemic therapies appear active. These results support the effectiveness and tolerability of PD-1i therapy in R/R cHL in a real-world setting. IMPLICATIONS FOR PRACTICE Two PD-1 inhibitors have recently been approved for patients with relapsed/refractory classical Hodgkin lymphoma based on results from nonrandomized clinical trials. However, to date, there have been no studies evaluating the effectiveness and toxicity profile of these drugs in the real-world setting in the U.S. The present study demonstrates that patients treated in a real-world context experience similar rates of overall effectiveness compared with published clinical trials. Patients who discontinue PD-1 inhibitors may experience clinical responses to subsequent treatment with systemic chemotherapy or targeted therapy. This study provides clinicians with further insight into the effectiveness and tolerability of PD-1 inhibitors and suggests that when patients progress while on these drugs, conventional systemic chemotherapy may be an effective treatment option.
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Affiliation(s)
- Steven M Bair
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren E Strelec
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gulrayz Ahmed
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Nirav N Shah
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Khoan Vu
- University of California, San Francisco, San Francisco, California, USA
| | | | - Smith Giri
- Yale University, New Haven, Connecticut, USA
| | | | - Christina Howlett
- Hackensack Medical Center, Hackensack, New Jersey, USA
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Malik Faheem
- Hackensack Medical Center, Hackensack, New Jersey, USA
| | - Matthew R Youngman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sunita D Nasta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J Landsburg
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Schuster
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jakub Svoboda
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Treatment-Resistant Hodgkin Lymphoma: Defining the Role of Autologous Transplantation. ACTA ACUST UNITED AC 2018; 24:244-248. [PMID: 30247260 DOI: 10.1097/ppo.0000000000000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autologous hematopoietic stem cell transplant (AHCT) remains the current standard of care for patients with relapsed or refractory Hodgkin lymphoma (HL) after frontline chemotherapy. However, treatment paradigms for HL are rapidly changing with positron emission tomography-adapted therapy, as well as the incorporation of brentuximab vedotin and checkpoint inhibitors into frontline, salvage, and maintenance therapy for HL. Patients who relapse or are refractory to these novel agents are likely to have different responses and outcomes with AHCT than the 3-year event-free survivals of 50% historically reported with AHCT for patients failing conventional combination chemotherapy. This article reviews the current data on the efficacy of AHCT, pretransplant prognostic markers, pretransplant salvage regimens, peritransplant radiation therapy, and posttransplant maintenance therapy in classic HL. Future research should reexamine the efficacy, timing, risk factors, pretransplant salvage regimens, and maintenance approaches posttransplant in the era of brentuximab vedotin and checkpoint inhibitors for HL.
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25
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Traila A, Dima D, Achimas-Cadariu P, Micu R. Fertility preservation in Hodgkin's lymphoma patients that undergo targeted molecular therapies: an important step forward from the chemotherapy era. Cancer Manag Res 2018; 10:1517-1526. [PMID: 29942153 PMCID: PMC6005299 DOI: 10.2147/cmar.s154819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In total, 80%-90% of Hodgkin's lymphoma (HL) patients are curable with combination chemoradiotherapy. Due to improvements in therapeutic strategies, 50% of all relapsed/refractory patients may undergo complete clinical responses and have long-term survival. Treatment options for HL are effective, but may have a negative impact on post-chemotherapy fertility. Thus, cryopreservation of semen prior to treatment is recommended for male patients. For female patients, assisted reproductive techniques (ART) consult and fertility preservation should be offered as a therapeutical option. In the last years, new targeted molecules have been available for HL treatment. These new drugs showed a high rate of overall responses in the setting of heavily pretreated patients, most of them in relapse after autologous stem cell transplantation, a group previously considered very poor risk. Up to 50% of patients have a complete response and an improved overall survival. Future studies will address the usefulness of novel molecules as a frontline therapy. Considering the high response and survival rates with monoclonal antibody-based therapeutics, fertility has become a concerning issue for long-term HL survivors. As progress has been made regarding ART, with the rigorous steps planned for HL patients, more survivors will become parents.
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Affiliation(s)
- Alexandra Traila
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Surgical Oncology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Patriciu Achimas-Cadariu
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Surgical Oncology, Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Romeo Micu
- School of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
- Department of Human Assisted Reproduction of 1st Gynecology Clinic, Cluj Napoca, Romania
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Bair SM, Mato A, Svoboda J. Immunotherapy for the Treatment of Hodgkin Lymphoma: An Evolving Paradigm. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:380-391. [PMID: 29685424 DOI: 10.1016/j.clml.2018.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 12/09/2022]
Abstract
Classical Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Although most patients are cured with standard first-line therapy, up to 20% of patients will have relapsed or refractory disease. Although the conventional approach to treatment has consisted of chemotherapy, radiation, and for those who relapse, autologous or allogeneic transplantation, newer approaches have become available in recent years, including immunoconjugates and checkpoint inhibitors. These approaches have shown significant efficacy in clinical trials and might be associated with fewer long-term toxicities compared with conventional therapies. In this review we discuss the biology of cHL as it pertains to the immunosuppressive tumor microenvironment and then review the existing clinical trial results of several emerging immunotherapies in this context, including immune checkpoint inhibitors and adoptive cellular therapy. Finally, several clinical practice issues pertaining to the use of immunotherapies are discussed.
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Affiliation(s)
- Steven M Bair
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
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27
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Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant. Ann Hematol 2018; 97:1229-1240. [PMID: 29484455 DOI: 10.1007/s00277-018-3283-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
Hodgkin lymphoma (HL) patients failing after high dose chemotherapy (HDC) and auto-SCT have a poor outcome. Some patients may still benefit from further treatments. From 1996 to 2016, 137 HL patients (39.5%) out of 347 transplanted experienced post auto-SCT failure. Males/female 61%:39%, median age at auto-SCT 23.4 years and median follow-up 55.6 months (9-153). Type of failure was progressive (46%), relapsed (35%) or persistent disease/refractory disease (19%). Median overall survival (OS) from the time of failure is 20 months; 35 patients (25.5%) are alive. One hundred and four patients received treatment; the response rate was 45%; complete remission in 41 (30%) and partial remission in 21 (15%) patients. 1st interventions post auto-SCT were chemotherapy (39%), radiation therapy (35%) or best supportive care (24%). Twenty-seven patients with 2nd-SCT (allogeneic (15), auto-SCT (2)) and/or brentuximab (18 patients) had superior OS (50.6 months) vs other treatments (22.5 months, P value 0.037). COX regression multivariate analysis identified post auto-SCT treatment failure before 12 months (hazard ratio (HR) 3.37, CI 1.7-6.6, P value < 0.001), presence of B symptoms (HR 2.55, CI 1.4-4.6, P value 0.002), stages III-IV (HR 2.7, CI 1.5-4.9, P value 0.001), albumin < 4 g/dl (HR 1.76, CI 1.1-2.9, P value 0.027) and tumor > 5 cm (HR 1.1.9, CI 1.13-3.25, P value 0.015) as significant risk factors; P value < 0.001. KM OS with 0-1 factor (148.6 months): 2 factors (23.6 months) and 3-5 factors (9.4 months) (P value < 0.001). OS was 63%:25%:7% respectively with 0-1:2:3-5 factors respectively (P value < 0.001). Despite high-risk factors, 2nd-SCT/brentuximab use post HDC auto-SCT failure may result in durable survival.
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