1
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Burlile JF, Frechette KM, Breen WG, Hwang SR, Higgins AS, Nedved AN, Harmsen WS, Pulsipher SD, Witzig TE, Micallef IN, Hoppe BS, Habermann TM, Thanarajasingam G, Johnston PB, Inwards DJ, Bennani NN, Peterson JL, Stish BJ, Rule WG, Ansell SM, Lester SC. Patterns of progression after immune checkpoint inhibitors for Hodgkin lymphoma: implications for radiation therapy. Blood Adv 2024; 8:1250-1257. [PMID: 38206755 PMCID: PMC10912840 DOI: 10.1182/bloodadvances.2023011533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Immune checkpoint inhibitors (ICIs) have demonstrated remarkable response rates in relapsed or refractory Hodgkin lymphoma (HL). Still, most patients eventually progress. Patterns of progression after ICIs are not well described and are essential to defining the role of local therapies in combination with ICIs. We identified patients who received ICIs for HL between 2013 and 2022. Fludeoxyglucose-18 positron emission tomography (FDG-PET) before initiating ICI and at progression on/after ICI were reviewed, and areas of active HL were recorded. An exploratory analysis of treatable progression included patients with ≤5 sites of disease on pre-ICI FDG-PET and progression only at pre-ICI sites. Ninety patients were identified; 69 had complete records, and of these, 32 (52%) had relapsed at ICI initiation, 17 (25%) were refractory, and 16 (23%) received ICI as first-line therapy. Forty-five of 69 patients had ≤5 sites of disease (limited) on pre-ICI FDG-PET. Patients with >5 sites of disease had a higher risk of progression, and every site of disease >5 sites conferred an additional 1.2x higher chance of progression. At a median follow-up of 4.0 years, 41 of 69 patients had progressed on/after ICIs (cumulative incidence 66.4%), and of these, 22 of 41 patients progressed only at pre-ICI sites (cumulative incidence 39.4%). In an exploratory analysis, the cumulative incidence of a treatable progression among 45 patients with limited disease was 34%. The cumulative incidence of any progression among this cohort was 58.9%. More than one-third of patients with limited disease before ICIs experienced progression only at pre-ICI sites of disease. These patients could be candidates for radiation during or after ICIs.
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Affiliation(s)
| | | | | | - Steven R. Hwang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | - William S. Harmsen
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sydney D. Pulsipher
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas E. Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ivana N. Micallef
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | - David J. Inwards
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - N. Nora Bennani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Stephen M. Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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2
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Driessen J, Zwezerijnen GJC, Schöder H, Kersten MJ, Moskowitz AJ, Moskowitz CH, Eertink JJ, Heymans MW, Boellaard R, Zijlstra JM. Prognostic model using 18F-FDG PET radiomics predicts progression-free survival in relapsed/refractory Hodgkin lymphoma. Blood Adv 2023; 7:6732-6743. [PMID: 37722357 PMCID: PMC10651466 DOI: 10.1182/bloodadvances.2023010404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/22/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
Investigating prognostic factors in patients with relapsed or primary refractory classical Hodgkin lymphoma (R/R cHL) is essential to optimize risk-adapted treatment strategies. We built a prognostic model using baseline quantitative 18F-fluorodeoxyglucose positron emission tomography (PET) radiomics features and clinical characteristics to predict the progression-free survival (PFS) among patients with R/R cHL treated with salvage chemotherapy followed by autologous stem cell transplantation. Metabolic tumor volume and several novel radiomics dissemination features, representing interlesional differences in distance, volume, and standard uptake value, were extracted from the baseline PET. Machine learning using backward selection and logistic regression were applied to develop and train the model on a total of 113 patients from 2 clinical trials. The model was validated on an independent external cohort of 69 patients. In addition, we validated 4 different PET segmentation methods to calculate radiomics features. We identified a subset of patients at high risk for progression with significant inferior 3-year PFS outcomes of 38.1% vs 88.4% for patients in the low-risk group in the training cohort (P < .001) and 38.5% vs 75.0% in the validation cohort (P = .015), respectively. The overall survival was also significantly better in the low-risk group (P = .022 and P < .001). We provide a formula to calculate a risk score for individual patients based on the model. In conclusion, we developed a prognostic model for PFS combining radiomics and clinical features in a large cohort of patients with R/R cHL. This model calculates a PET-based risk profile and can be applied to develop risk-stratified treatment strategies for patients with R/R cHL. These trials were registered at www.clinicaltrials.gov as #NCT02280993, #NCT00255723, and #NCT01508312.
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Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Division of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Gerben J. C. Zwezerijnen
- Division of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Lymphoma and Myeloma Center Amsterdam, Amsterdam, The Netherlands
| | - Alison J. Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Craig H. Moskowitz
- Department of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jakoba J. Eertink
- Division of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Division of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Josée M. Zijlstra
- Division of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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3
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Damlaj M, Tlayjeh M, Damlaj A, Alahmari B, AlSadi H, Ahmed M, AlJubour Z, Alhejazi A, Salama H, Ibrahim A, Al Raizah A, Bakkar M, Ghori A, Al Saleh AS, Alaskar A, Alzahrani M. Contemporary outcomes of high risk relapsed refractory classical hodgkin lymphoma patients-role of maintenance therapy in the real world. Bone Marrow Transplant 2023; 58:1160-1162. [PMID: 37464089 DOI: 10.1038/s41409-023-02036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Moussab Damlaj
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE.
- Khalifa University, Abu Dhabi, UAE.
| | | | | | - Bader Alahmari
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Husam AlSadi
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mazin Ahmed
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Zied AlJubour
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hend Salama
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ayman Ibrahim
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman Al Raizah
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Bakkar
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulraouf Ghori
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah S Al Saleh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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4
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Husi K, Szabó R, Pinczés LI, Földeák D, Dudley R, Szomor Á, Koller B, Gopcsa L, Illés Á, Miltényi Z. Improved survival of autologous stem cell transplantation in primary refractory and relapsed Hodgkin lymphoma in the brentuximab vedotin era - real-world data from Hungary. Ann Hematol 2023; 102:2555-2563. [PMID: 37428200 PMCID: PMC10444678 DOI: 10.1007/s00277-023-05354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
Autologous stem cell transplantation (ASCT) is the standard treatment of primary refractory or relapsed Hodgkin-lymphoma, which can provide a cure rate of about 50%. The aim of our study was to analyze the data of 126 HL patients undergoing AHSCT in Hungary between 01/01/2016 and 31/12/2020. We assessed the progression-free and overall survival, the prognostic role of PET/CT performed before transplantation and effect of brentuximab vedotin (BV) treatment on survival outcomes. The median follow-up time from AHSCT was 39 (1-76) months. The 5-year OS comparing PET- and PET + patients was 90% v. 74% (p = 0.039), and 5-year PFS was 74% v. 40% (p = 0.001). There was no difference in either OS or PFS compared to those who did not receive BV before AHSCT. We compared BV treatments based on their indication (BV only after AHSCT as maintenance therapy, BV before and after AHSCT as maintenance treatment, BV only before AHSCT, no BV treatment). There was statistically significant difference in the 5-year PFS based on the inication of BV therapy. Recovery rates of our R/R HL patient population, who underwent AHSCT, improved significantly. Our positive results can be attributed to the PET/CT directed, response-adapted treatment approach, and the widespread use of BV.
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Affiliation(s)
- Kata Husi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Roxána Szabó
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
| | - Dóra Földeák
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Réka Dudley
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Árpád Szomor
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Beáta Koller
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - László Gopcsa
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsófia Miltényi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary.
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
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5
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Impact of pre- and/or post-autologous stem cell transplantation exposure to brentuximab vedotin on survival outcomes in patients with high-risk Hodgkin lymphoma. Ann Hematol 2023; 102:429-437. [PMID: 36370191 DOI: 10.1007/s00277-022-05011-6] [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: 05/17/2022] [Accepted: 10/12/2022] [Indexed: 11/15/2022]
Abstract
The AETHERA trial demonstrated that brentuximab vedotin (BV) consolidation after autologous stem cell transplantation (ASCT) in patients with Hodgkin lymphoma (HL) at high risk of relapse/progression increases progression-free survival (PFS). Patients previously exposed to BV were excluded from that trial. However, BV alone or in combination with chemotherapy is frequently used as front-line treatment and/or pre-ASCT salvage therapy. We analyzed data from 156 patients with high-risk HL who underwent ASCT with (BV-CON, n = 62) or without (non-BV, n = 94) BV consolidation. Fifty-seven patients received BV-based salvage regimens before ASCT. The 3-year overall survival and PFS for all patients were 91.6% and 70.0%, respectively. Multivariate analysis showed that BV-CON was associated with better PFS (HR 0.39, p = 0.01), whereas positive PET at transplant leaded to worse PFS (HR 2.71, p = 0.001). BV-CON improved PFS in PET-positive patients (72.2% vs. 43.0%, p = 0.05), with a beneficial trend observed in PET negative (88.8% vs. 75.2%, p = 0.09). BV-CON patients with or without BV exposure pre-ASCT had a significantly better PFS than non-BV with or without BV pretransplant treatment (HR 0.36, p = 0.004). The efficacy of real-life BV consolidation therapy was similar to that in the AETHERA trial. This therapeutic strategy improves survival independently of BV exposure prior to ASCT.
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6
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Kosydar S, Ansell SM. Long-term outcomes for patients with Hodgkin lymphoma at increased risk of progression or relapse. Leuk Lymphoma 2023; 64:5-17. [PMID: 36215148 DOI: 10.1080/10428194.2022.2131422] [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: 11/06/2022]
Abstract
Although advancements in the treatment of Hodgkin lymphoma have enabled many patients to be cured of their disease, about half of patients who relapse or experience refractory disease ultimately fail treatment, even after autologous stem cell transplant. Risk stratification is crucial to enable escalation of therapy in patients at increased risk for progression while allowing for less intensive therapy in lower risk groups. Utilization of clinical factors to inform risk scores was common practice, but this historical approach has been supplemented by PET/CT risk adapted management. Long-term outcomes of high-risk patients have improved over the decades with advancements in therapy and emergence of novel agents including antibody-drug conjugates and immune checkpoint inhibitors, yet further research is urgently needed. Herein, we review long-term outcomes of patients with Hodgkin lymphoma at increased risk for progression or relapse and discuss limitations of current risk strategies.
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Affiliation(s)
- Samuel Kosydar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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7
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Al-Juhaishi T, Borogovac A, Ibrahimi S, Wieduwilt M, Ahmed S. Reappraising the Role of Allogeneic Hematopoietic Stem Cell Transplantation in Relapsed and Refractory Hodgkin’s Lymphoma: Recent Advances and Outcomes. J Pers Med 2022; 12:jpm12020125. [PMID: 35207613 PMCID: PMC8880200 DOI: 10.3390/jpm12020125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/07/2022] Open
Abstract
Hodgkin’s lymphoma is a rare yet highly curable disease in the majority of patients treated with modern chemotherapy regimens. For patients who fail to respond to or relapse after initial systemic therapies, treatment with high-dose chemotherapy and autologous hematopoietic stem cell transplantation can provide a cure for many with chemotherapy-responsive lymphoma. Patients who relapse after autologous transplant or those with chemorefractory disease have poor prognosis and represent a high unmet need. Allogeneic hematopoietic stem cell transplantation provides a proven curative therapy for these patients and should be considered, especially in young and medically fit patients. The use of newer agents in this disease such as brentuximab vedotin and immune checkpoint inhibitors can help bring more patients to transplantation and should be considered as well.
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Affiliation(s)
- Taha Al-Juhaishi
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
- Correspondence: ; Tel.: +1-40527-18001
| | - Azra Borogovac
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Sami Ibrahimi
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Matthew Wieduwilt
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (A.B.); (S.I.); (M.W.)
| | - Sairah Ahmed
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA;
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8
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Outcomes of adults with lymphoma treated with nonmyeloablative TLI-ATG and radiation boost to high risk or residual disease before allogeneic hematopoietic cell transplant. Bone Marrow Transplant 2022; 57:106-112. [PMID: 34671121 DOI: 10.1038/s41409-021-01495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 02/08/2023]
Abstract
We evaluated the impact on survival of antithymocyte globulin conditioning (TLI-ATG) with radiation (RT) boost to high risk or residual disease before allogeneic hematopoietic cell transplant (allo-HCT) for adults with lymphoma (excluding mycosis fungoides and low-grade NHL other than SLL/CLL). Of 251 evaluable patients, 36 received an RT boost within 3 months of allo-HCT at our institution from 2001 to 2016. At the time of TLI-ATG, patients who received boost vs no boost had a lower rate of CR (11% vs 47%, p = 0.0003), higher rates of bulky disease (22% vs 4%, p < 0.0001), extranodal disease (39% vs 5%, p < 0.0001), and positive PET (75% vs 28%, p < 0.00001). In the boost group, the median (range) largest axial lesion diameter was 5.2 cm (1.8-22.3). Median follow-up was 50.2 months (range: 1-196). There was no significant difference in OS, time to recurrence, or time to graft failure with vs without boost. A trend toward higher percent donor CD3+ chimerism was seen with vs without boost (p = 0.0819). The worst boost-related toxicity was grade 2 dermatitis. RT boost may help successfully mitigate the risk of high risk or clinically evident residual disease in adults with lymphoma undergoing allo-HCT.
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9
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Abuelgasim KA, Ghazi S, Alahmari B, Alhejazi A, Alaskar A, Alzahrani M, Damlaj M. Promising remissions in relapsed refractory classical Hodgkin lymphoma patients requiring multiple salvage regimens before transplantation in the brentuximab vedotin era. Leuk Res Rep 2021; 16:100276. [PMID: 34804792 PMCID: PMC8581367 DOI: 10.1016/j.lrr.2021.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/18/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Relapsed/refractory classical Hodgkin lymphoma (R/R cHL) patients refractory to first line salvage have poor outcomes. Herein we report the outcome of R/R cHL patients requiring ≥two vs. one line in the era of chemo-immunotherapy. Among 55 R/R cHL patients, 33 (60%) required one, 22 (40%) required ≥two lines. At 2 years, the estimated PFS and OS for patients requiring one vs. ≥two lines was 71.2% (50.1–84.7) vs. 51.9% (27.6–71.6), p= 0.16 and 84.6% (63–94) vs. 84% (58–95), p= 0.88, respectively. Patients requiring ≥two salvage lines prior to HCT can achieve comparable outcomes to those requiring one, possibly due to brentuximab vedotin leading to higher CMR rates.
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Affiliation(s)
- Khadega A Abuelgasim
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Samer Ghazi
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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10
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Gutiérrez-García G, Martínez C, Boumendil A, Finel H, Malladi R, Afanasyev B, Tsoulkani A, Wilson KMO, Bloor A, Nikoloudis M, Richardson D, López-Corral L, Castagna L, Cornelissen J, Giltat A, Collin M, Fanin R, Bonifazi F, Robinson S, Montoto S, Peggs KS, Sureda A. Long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation as first transplant for high-risk Hodgkin lymphoma: a retrospective analysis from the Lymphoma Working Party-EBMT. Br J Haematol 2021; 196:1018-1030. [PMID: 34750806 DOI: 10.1111/bjh.17939] [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: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
We analysed long-term outcome of patients receiving haematopoietic allogeneic stem cell transplantation (allo-HSCT) as a first transplant for high-risk Hodgkin lymphoma (HL). One hundred and ninety patients were included in this study, 63% of them had previously received brentuximab vedotin and/or checkpoint inhibitors. Seventy patients (37%) received an unrelated donor allo-HSCT, 99 (51%) had myeloablative conditioning (MAC) and 60% had in vivo T-cell/depleted grafts (TCD). The 100-day cumulative incidence (CI) of grade II-IV acute graft-versus-host disease (GVHD) was 25% and the 3-year CI of chronic GVHD was 38%. The 3-year CI of non-relapse mortality (NRM) and relapse rate were 21% and 38% respectively. After a median follow-up of 58 months, 3-year overall survival (OS) and progression-free survival (PFS) were 58% and 41% respectively. Multivariate analysis showed that, in comparison to reduced-intensity conditioning regimens with or without TCD, MAC using TCD had similar NRM and a lower risk of relapse leading to significantly better OS and PFS. MAC without TCD was associated with higher NRM and worse survival outcomes. These results suggest that in patients with high-risk HL and candidates of allo-HSCT, a MAC strategy with TCD might be the best option.
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Affiliation(s)
- G Gutiérrez-García
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - C Martínez
- Department of Haematology, Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, University of Barcelona, Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | | | - H Finel
- Lymphoma Working Party, EBMT, Paris, France
| | - R Malladi
- School of Cancer Sciences, University of Birmingham, Centre for Clinical Haematology, Queen Elizabeth NHS Foundation Trust, Birmingham, UK
| | - B Afanasyev
- State Medical Pavlov University, St. Petersburg, Russia
| | | | | | - A Bloor
- Haematology and Transplant Unit, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester, UK
| | - M Nikoloudis
- Haematology Department Heart of England NHS Trust, Birmingham, UK
| | - D Richardson
- Department of Haematology, Southampton General Hospital, Southampton, UK
| | | | - L Castagna
- Department of Haematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Cornelissen
- Erasmus MC Cancer Institute University Medical Centre Rotterdam Department of Haematology, Rotterdam, Netherlands
| | - A Giltat
- Department of Haematology, Medical University Hospital, Angers, France
| | | | - R Fanin
- Department of Haematology and Cellular Therapy 'Carlo Melzi', S. Maria della Misericordia University Hospital, DAME, University of Udine, Udine, Italy
| | - F Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - S Robinson
- Department of Haematology and Oncology, Bristol University Hospital, Bristol, UK
| | - S Montoto
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - K S Peggs
- Department of Haematology, University College London Cancer Institute, London, UK
| | - A Sureda
- Clinical Department of Haematology, Institut Català d'Oncologia-Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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11
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Massaro F, Pavone V, Stefani PM, Botto B, Pulsoni A, Patti C, Cantonetti M, Visentin A, Scalzulli PR, Rossi A, Galimberti S, Cimminiello M, Gini G, Musso M, Sorio M, Arcari A, Zilioli VR, Luppi M, Mannina D, Fabbri A, Pietrantuono G, Annibali O, Tafuri A, Prete E, Mulè A, Barbolini E, Marcheselli L, Luminari S, Merli F. Brentuximab vedotin consolidation after autologous stem cell transplantation for Hodgkin lymphoma: A Fondazione Italiana Linfomi real-life experience. Hematol Oncol 2021; 40:31-39. [PMID: 34694649 PMCID: PMC9298220 DOI: 10.1002/hon.2939] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022]
Abstract
The standard management for relapsed or refractory classical Hodgkin lymphoma (cHL) is salvage therapy followed by autologous stem cell transplantation (ASCT). This strategy allows almost 50% of patients to be cured. Post-ASCT maintenance treatment with brentuximab vedotin (BV) confers improved progression-free survival (PFS) to cHL patients at high risk of relapse. We investigated the outcome of 105 cHL patients receiving post-ASCT BV maintenance in the real-life setting of 23 Italian hematology centers. This population included naïve patients and those previously exposed to BV. Median follow-up was 20 months. Patients presented a median of two lines of treatment pre-ASCT, with 51% receiving BV. Twenty-nine percent of patients had at least two high-risk factors (refractory disease, complete response [CR] less than 12 months, extranodal disease at relapse), while 16% presented none. At PET-CT, a Deauville score (DS) of 1-3 was reported in 75% and 78% of pre- and post-ASCT evaluations, respectively. Grade 3-4 adverse events (AEs), mainly peripheral neuropathy, were observed in 16% of patients. Three-year PFS and overall survival (OS) were 62% and 86%, respectively. According to BV exposure, 3-year PFS and OS were 54% and 71%, respectively, for naïve and 77% and 96%, respectively, for previously exposed patients. Refractory disease (hazard ratio [HR] 4.46; p = 0.003) and post-ASCT DS 4-5 (HR 3.14; p = 0.005) were the only two factors significantly associated with PFS reduction in multivariable analysis. Post-ASCT BV maintenance is an effective, safe treatment option for cHL naïve patients and those previously exposed to BV.
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Affiliation(s)
- Fulvio Massaro
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | | | - Barbara Botto
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Caterina Patti
- Division of Onco-Hematology, Azienda Villa Sofia-Cervello, Palermo, Italy
| | - Maria Cantonetti
- Unit of Lymphoproliferative Disorders, Policlinico Tor Vergata, Rome, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Andrea Rossi
- Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Guido Gini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Maurizio Musso
- Department of Oncology, Hematology and BMT Unit, Casa di Cura La Maddalena, Palermo, Italy
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | - Annalisa Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Donato Mannina
- Unit of Haematology, Azienda Ospedaliera Papardo, Messina, Italy
| | - Alberto Fabbri
- Hematology, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giuseppe Pietrantuono
- Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Ombretta Annibali
- Unit of Haematology and Stem Cell Transplantation, Campus Bio-Medico University, Rome, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine and Hematology, Sant'Andrea - University Hospital - Sapienza, University of Rome, Rome, Italy
| | - Eleonora Prete
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | - Antonino Mulè
- Division of Onco-Hematology, Azienda Villa Sofia-Cervello, Palermo, Italy
| | - Elisa Barbolini
- Gruppo Amici dell'Ematologia GRADE-Onlus Foundation, Reggio Emilia, Italy
| | | | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Akay OM, Ozbalak M, Pehlivan M, Yildiz B, Uzay A, Yigenoglu TN, Elverdi T, Kaynar L, Ayyildiz O, Yonal Hindilerden I, Goksoy HS, Izmir Guner S, Gunes AK, Sonmez M, Kurt Yuksel M, Civriz Bozdag S, Ozkurt ZN, Toptas T, Dogu MH, Salim O, Saydam G, Yavasoglu I, Ayli M, Ozet G, Albayrak M, Birtas Atesoglu E, Toprak SK, Yildirim R, Mehtap O, Kalayoglu Besisik S, Nalcaci M, Altuntas F, Ferhanoglu B. Brentuximab vedotin consolidation therapy after autologous stem-cell transplantation in patients with high-risk Hodgkin lymphoma: Multicenter retrospective study. Hematol Oncol 2021; 39:498-505. [PMID: 34171130 DOI: 10.1002/hon.2897] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/03/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022]
Abstract
The AETHERA trial reported an increased progression-free survival (PFS) when brentuximab vedotin (BV) was used as maintenance therapy in high-risk Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT). Thus, we aimed to determine the impact and safety of BV as maintenance after ASCT in real-world patients. Seventy-five patients with relapsed/refractory HL started on BV consolidation therapy after ASCT due to high risk of relapse, between January 2016 and July 2019, from 25 institutions, were included in the study. The median follow-up time was 26 months. The most common high-risk features were primary refractory or relapsed disease <12 months (n = 61), lack of complete response (CR) to the last salvage regimen (n = 51), and having had at least two salvage regimens (n = 29). At the time of analysis, 42 patients completed consolidation courses, and BV was discontinued in 33 patients. Fifty patients had an ongoing response (CR in 41, PR in 6, and SD in 3 patients), 25 had progressed. Ten died in the follow-up, eight with progressive disease and two due to infection while in CR. The 2-year PFS and OS rates were 67.75% (95% confidence interval [CI]: 0.55-0.77) and 87.61% (95% CI: 0.76-0.94), respectively. Seventeen patients (23%) received BV in the pre-ASCT treatment lines, and there was no survival difference between the BV-naïve and BV-exposed groups. The most common adverse events were neutropenia (27%) and peripheral neuropathy (21%). Sixteen patients (21.3%) experienced grade 3 or 4 toxicity. BV was discontinued due to adverse event in 12 patients. Consolidation with BV after ASCT can achieve a 2-year PFS of 67.75% (95% CI: 0.55-0.75) with an acceptable toxicity profile.
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Affiliation(s)
- Olga Meltem Akay
- Department of Internal Medicine, Division of Hematology, Koç University Medical Faculty, Istanbul, Turkey
| | - Murat Ozbalak
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Pehlivan
- Department of Internal Medicine, Division of Hematology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Birol Yildiz
- Department of Internal Medicine, Division of Medical Oncology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Ant Uzay
- Depatment of Hematology, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Tugce Nur Yigenoglu
- Division of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Tugrul Elverdi
- Department of Internal Medicine, Division of Hematology, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Leylagul Kaynar
- Department of Internal Medicine, Division of Hematology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Orhan Ayyildiz
- Department of Internal Medicine, Division of Hematology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ipek Yonal Hindilerden
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hasan Sami Goksoy
- Depatment of Hematology, Yeniyuzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey
| | | | | | - Mehmet Sonmez
- Department of Internal Medicine, Division of Hematology, Karadeniz Technical University, Trabzon, Turkey
| | - Meltem Kurt Yuksel
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Sinem Civriz Bozdag
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Zubeyde Nur Ozkurt
- Department of Internal Medicine, Division of Hematology, Gazi University Medical Faculty, Ankara, Turkey
| | - Tayfur Toptas
- Department of Internal Medicine, Division of Hematology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Mehmet Hilmi Dogu
- Division of Hematology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Ozan Salim
- Department of Internal Medicine, Division of Hematology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Guray Saydam
- Department of Internal Medicine, Division of Hematology, Ege University Medical Faculty, Izmir, Turkey
| | - Irfan Yavasoglu
- Department of Internal Medicine, Division of Hematology, Adnan Menderes University Medical Faculty, Aydın, Turkey
| | - Meltem Ayli
- Department of Internal Medicine, Division of Medical Oncology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Gulsum Ozet
- Division of Hematology, Ankara City Hospital, Ankara, Turkey
| | - Murat Albayrak
- Division of Hematology, Dışkapı Research and Training Hospital, Ankara, Turkey
| | | | - Selami K Toprak
- Department of Internal Medicine, Division of Hematology, Ankara University Medical Faculty, Ankara, Turkey
| | - Rahsan Yildirim
- Department of Internal Medicine, Division of Hematology, Ataturk University Medical Faculty, Erzurum, Turkey
| | - Ozgur Mehtap
- Department of Internal Medicine, Division of Hematology, Kocaeli University Medical Faculty, İzmit, Turkey
| | - Sevgi Kalayoglu Besisik
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Meliha Nalcaci
- Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fevzi Altuntas
- Division of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Burhan Ferhanoglu
- Department of Internal Medicine, Division of Hematology, Koç University Medical Faculty, Istanbul, Turkey.,Division of Hematology, V.K.V. American Hospital, İstanbul, Turkey
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13
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Autologous stem cell transplantation after anti-PD-1 therapy for multiply relapsed or refractory Hodgkin lymphoma. Blood Adv 2021; 5:1648-1659. [PMID: 33710337 DOI: 10.1182/bloodadvances.2020003556] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/10/2021] [Indexed: 01/14/2023] Open
Abstract
Autologous stem cell transplantation (ASCT) can be curative for patients with relapsed/refractory Hodgkin lymphoma (HL). Based on studies suggesting that anti-PD-1 monoclonal antibodies (mAbs) can sensitize patients to subsequent chemotherapy, we hypothesized that anti-PD-1 therapy before ASCT would result in acceptable outcomes among high-risk patients who progressed on or responded insufficiently to ≥1 salvage regimen, including chemorefractory patients who are traditionally considered poor ASCT candidates. We retrospectively identified 78 HL patients who underwent ASCT after receiving an anti-PD-1 mAb (alone or in combination) as third-line or later therapy across 22 centers. Chemorefractory disease was common, including 42 patients (54%) refractory to ≥2 consecutive systemic therapies immediately before anti-PD-1 treatment. Fifty-eight (74%) patients underwent ASCT after anti-PD-1 treatment, while 20 patients (26%) received additional therapy after PD-1 blockade and before ASCT. Patients received a median of 4 systemic therapies (range, 3-7) before ASCT, and 31 patients (41%) had a positive pre-ASCT positron emission tomography (PET) result. After a median post-ASCT follow-up of 19.6 months, the 18-month progression-free survival (PFS) and overall survival were 81% (95% CI, 69-89) and 96% (95% confidence interval [CI], 87-99), respectively. Favorable outcomes were observed for patients who were refractory to 2 consecutive therapies immediately before PD-1 blockade (18-month PFS, 78%), had a positive pre-ASCT PET (18-month PFS, 75%), or received ≥4 systemic therapies before ASCT (18-month PFS, 73%), while PD-1 nonresponders had inferior outcomes (18-month PFS, 51%). In this high-risk cohort, ASCT after anti-PD-1 therapy was associated with excellent outcomes, even among heavily pretreated, previously chemorefractory patients.
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14
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Kersten MJ, Driessen J, Zijlstra JM, Plattel WJ, Morschhauser F, Lugtenburg PJ, Brice P, Hutchings M, Gastinne T, Liu R, Burggraaff CN, Nijland M, Tonino SH, Arens AIJ, Valkema R, van Tinteren H, Lopez-Yurda M, Diepstra A, De Jong D, Hagenbeek A. Combining brentuximab vedotin with dexamethasone, high-dose cytarabine and cisplatin as salvage treatment in relapsed or refractory Hodgkin lymphoma: the phase II HOVON/LLPC Transplant BRaVE study. Haematologica 2021; 106:1129-1137. [PMID: 32273476 PMCID: PMC8018114 DOI: 10.3324/haematol.2019.243238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplant (auto-PBSCT) predicts progression free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP to improve the mCR rate. In a Phase I dose-escalation part in 12 patients, we showed that BV-DHAP is feasible. This Phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40mg days 1-4, cisplatin 100mg/m2; day 1 and cytarabine 2x2g/m2; day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central FDG-PET-CT review, 42 of 52 evaluable patients (81% [95% CI: 67-90]) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (three were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. The 2-year PFS was 74% [95% CI: 63-86], and the overall survival 95% [95% CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematological toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2) and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2) and all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. ClinicalTrials.gov identifier: NCT02280993.
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Affiliation(s)
- Marie José Kersten
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Julia Driessen
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Plattel
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | | | | | - Pauline Brice
- Dept of Hematology, Hopital Saint Louis, Paris, France
| | | | - Thomas Gastinne
- Dept of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Roberto Liu
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Coreline N Burggraaff
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel Nijland
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | - Sanne H Tonino
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Anne I J Arens
- Dept of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Roelf Valkema
- Dept of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm van Tinteren
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marta Lopez-Yurda
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjan Diepstra
- Dept. of Pathology and Medical Biology, UMC Groningen, University of Groningen, the Netherlands
| | - Daphne De Jong
- Dept of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Hagenbeek
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
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15
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Abstract
The appropriate selection of patients to undergo hematopoietic stem cell transplant (HSCT) is critical due to the risk of treatment-related morbidity and mortality. The prognostic value of FDG-PET/CT in response assessment in hematologic malignancies is well-established and has led to numerous investigations into the role of FDG-PET/CT in the evaluation of patients in the setting of HSCT. This article discusses the most common indications for autologous stem cell transplant (autoSCT) in which FDG-PET/CT has been evaluated, including for lymphoma and multiple myeloma. For relapsed/refractory Hodgkin lymphoma, achieving a negative FDG-PET/CT scan, regardless of the number of the regimens, prior to autoSCT is an important prognostic factor for posttransplant outcome. The data in the pretransplant setting are more variable for non-Hodgkin lymphoma. For both Hodgkin and non-Hodgkin lymphoma, studies have primarily used a visual assessment for FDG-PET/CT interpretation, with the Deauville score the current standard criteria. Optimization of thresholds for specific regimens pretransplant as well as integration of additional semiquantitative parameters to assess response remain active areas of research. For multiple myeloma, FDG-PET/CT has emerged as the recommended imaging modality of choice for assessing response to treatment. Data suggest that FDG-PET/CT may provide prognostic and predictive value for assessing outcome after autoSCT.
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Affiliation(s)
- Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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16
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Carreau NA, Pail O, Armand P, Merryman R, Advani RH, Spinner MA, Herrera A, Chen R, Tomassetti S, Ramchandren R, Hamid MS, Assouline S, Santiago R, Wagner-Johnston N, Paul S, Svoboda J, Bair S, Barta S, Liu Y, Nathan S, Karmali R, Burkart M, Torka P, David K, Wei C, Lansigan F, Emery L, Persky D, Smith S, Godfrey J, Chavez J, Xia Y, Troxel AB, Diefenbach C. Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy. Oncologist 2020; 25:878-885. [PMID: 32720734 DOI: 10.1634/theoncologist.2020-0167] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy. MATERIALS AND METHODS Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post-CBT treatment using the Lugano criteria. Secondary aims included progression-free survival (PFS), duration of response, and overall survival (OS). RESULTS Eighty-one patients were included. Seventy-two percent had stage III-IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post-CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post-CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post-CBT regimen. CONCLUSION In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post-CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials. IMPLICATIONS FOR PRACTICE Novel, life-prolonging treatment strategies in relapsed and refractory (R/R) Hodgkin lymphoma (HL) are greatly desired. The results of this multicenter analysis concur with a smaller, earlier report that checkpoint blockade therapy (CBT) use in R/R HL may sensitize patients to their subsequent treatment. This approach may potentially enhance therapeutic options or to bridge patients to transplant. Prospective data are warranted prior to practice implementation. As more work is done in this area, we may also be able to optimize sequencing of CBT and novel agents in the treatment paradigm to minimize treatment-related toxicity and thus improve patient quality of life.
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Affiliation(s)
- Nicole A Carreau
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, New York, USA
| | - Orrin Pail
- Department of Medicine, New York University School of Medicine & Langone Medical Center, New York, New York, USA
| | - Philippe Armand
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Reid Merryman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ranjana H Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, USA
| | - Michael A Spinner
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, USA
| | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Sarah Tomassetti
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Radhakrishnan Ramchandren
- Division of Hematology and Oncology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Muhammad S Hamid
- Department of Oncology, Karmanos Cancer Institute, Detroit, Michigan, USA
| | | | | | - Nina Wagner-Johnston
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Suman Paul
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jakub Svoboda
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Bair
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefan Barta
- Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yang Liu
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Sunita Nathan
- Rush University Medical Center, Chicago, Illinois, USA
| | - Reem Karmali
- Division of Hematology, Northwestern University, Chicago, Illinois, USA
| | - Madelyn Burkart
- Division of Hematology, Northwestern University, Chicago, Illinois, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Kevin David
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Catherine Wei
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | | | - Lukas Emery
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Daniel Persky
- Division of Hematology/Oncology, University of Arizona Cancer Center, Tucson, Arizona, USA
| | | | | | | | - Yuhe Xia
- New York University School of Medicine, New York, New York, USA
| | - Andrea B Troxel
- New York University School of Medicine, New York, New York, USA
| | - Catherine Diefenbach
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, New York, USA
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17
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Brentuximab vedotin containing salvage followed by consolidation post autologous hematopoietic stem cell transplantation in high risk relapsed refractory classical Hodgkin lymphoma. Bone Marrow Transplant 2020; 55:2322-2325. [PMID: 32404976 DOI: 10.1038/s41409-020-0935-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023]
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18
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Outcome after autologous stem cell transplantation in primary refractory or relapsed Hodgkin lymphoma-a long-term follow-up single center experience. Ann Hematol 2020; 99:265-276. [PMID: 31897675 DOI: 10.1007/s00277-019-03900-x] [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: 08/04/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent "real world" cohort.
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19
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The German Hodgkin Study Group risk model is useful for Hodgkin lymphoma patients receiving radiotherapy after autologous stem cell transplant. Cancer Radiother 2019; 23:378-384. [DOI: 10.1016/j.canrad.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 11/23/2022]
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20
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Moreira J, Platanias LC, Adekola KUA. It's all about the CD3+ T-cells: how circulating immune cell subset analyses can predict early relapse in Hodgkin lymphoma. Leuk Lymphoma 2019; 60:2345-2347. [PMID: 31451048 DOI: 10.1080/10428194.2019.1646909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago , IL , USA.,Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Leonidas C Platanias
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago , IL , USA.,Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University , Chicago , IL , USA.,Department of Medicine, Jesse Brown VA Medical Center , Chicago , IL , USA
| | - Kehinde U A Adekola
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University , Chicago , IL , USA.,Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
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21
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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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22
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Sequential immunotherapy in a patient with primary refractory Hodgkin lymphoma and novel mutations. Oncotarget 2018; 9:20928-20940. [PMID: 29755699 PMCID: PMC5945535 DOI: 10.18632/oncotarget.25037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
Primary resistant Hodgkin lymphoma is an aggressive disease with few treatment options and short survival. Neoplastic cells of classical Hodgkin lymphoma are heavily dependent on microenvironmental stimuli, regularly express PD-L1, and a relevant proportion of relapsed patients is sensitive to blocking of the PD1/PD-L1 axis. However, response duration is limited and further treatment options are unknown but urgently needed. We report a case of a patient without relevant response to five subsequent chemotherapy regimens who immediately and dramatically responded to an anti-PD1 mab. During the following two years she responded to the anti-CTLA-4 mab ipilimumab, the Jak2 inhibitor ruxolitinib, and a combination of lenalidomide plus cyclophosphamide given in subsequent relapses. A thorough genomic analysis demonstrated seven genomic alterations with six of them not previously described in this disease (i.e. BRIP1 G212fs*62, KRAS L19F, KDM5A R1239W, MYC A59T, ARIDA1A E1683fs*15 and TP53 277Y). Three alterations were considered actionable and one of them drugable. The number of mutations increased over time and the BRIP1 mutation was found to be a germline mutation.
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Shah GL, Moskowitz CH. Transplant strategies in relapsed/refractory Hodgkin lymphoma. Blood 2018; 131:1689-1697. [PMID: 29500170 PMCID: PMC5897866 DOI: 10.1182/blood-2017-09-772673] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023] Open
Abstract
The majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy. However, high-dose therapy with autologous hematopoietic cell transplant (AHCT) allows for the cure of an additional portion of patients with relapsed or primary refractory disease. Positron emission tomography-negative complete remission before AHCT is critical for long-term disease control. Several salvage options are available with comparable response rates, and the choice can be dependent of comorbidities and logistics. Radiation therapy can also improve the remission rate and is an important therapeutic option for selected patients. Brentuximab vedotin (BV) maintenance after AHCT is beneficial in patients at high risk for relapse, especially those with more than 1 risk factor, but can have the possibility of significant side effects, primarily neuropathy. Newer agents with novel mechanisms of action are under investigation to improve response rates for patients with subsequent relapse, although are not curative alone. BV and the checkpoint inhibitors nivolumab and pembrolizumab are very effective with limited side effects and can bridge patients to curative allogeneic transplants (allo-HCT). Consideration for immune-mediated toxicities, timing of allogeneic hematopoietic cell transplant based on response, and the potential for increased graft-versus-host disease remain important. Overall, prospective investigations continue to improve outcomes and minimize toxicity for relapsed or primary refractory HL patients.
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Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Craig H Moskowitz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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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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Mariotti J, Bramanti S, Devillier R, Furst S, El Cheikh J, Sarina B, Granata A, Faucher C, Harbi S, Morabito L, Weiller PJ, Chabannon C, Mokart J, Mineri R, Carlo-Stella C, Santoro A, Blaise D, Castagna L. Tandem autologous-haploidentical transplantation is a feasible and effective program for refractory Hodgkin lymphoma. Bone Marrow Transplant 2017; 53:366-370. [DOI: 10.1038/s41409-017-0032-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022]
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26
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High dose chemotherapy and autologous stem cell transplantation in relapsed or refractory Hodgkin lymphoma: Emerging questions, newer agents, and changing paradigm. Hematol Oncol Stem Cell Ther 2017. [DOI: 10.1016/j.hemonc.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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27
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Zagadailov EA, Corman S, Chirikov V, Johnson C, Macahilig C, Seal B, Dalal MR, Bröckelmann PJ, Illidge T. Real-world effectiveness of brentuximab vedotin versus physicians' choice chemotherapy in patients with relapsed/refractory Hodgkin lymphoma following autologous stem cell transplantation in the United Kingdom and Germany. Leuk Lymphoma 2017; 59:1413-1419. [PMID: 29045163 DOI: 10.1080/10428194.2017.1382698] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This retrospective study compared effectiveness of (brentuximab vedotin) BV to other chemotherapies in patients with rrHL following an autologous stem cell transplant (ASCT). Data originated from a medical chart review of patients treated in real-world clinical settings at 50 sites in the United Kingdom and Germany. Inverse probability of treatment weights based on propensity scores were used to adjust for differences in baseline characteristics between treatment groups. Among 312 rrHL patients included, 196 received BV and 116 received physicians' choice chemotherapy. Median PFS was significantly longer (27.0 months vs. 13.4 months; p = .0144) and 12-month OS survival greater (78.1% vs. 65.9%; p = .0129) with BV compared to chemotherapy. Documented adverse events included leukopenia (12.8%) and peripheral neuropathy (8.7%) for BV and leukopenia (12.1%), anemia (5.2%) and diarrhea (5.2%) for chemotherapy. In this real-world study, rrHL patients treated for relapse after ASCT with BV had longer median PFS and 12-month OS than patients receiving chemotherapy.
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Affiliation(s)
- Erin A Zagadailov
- a Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | | | | | | | | | | | - Mehul R Dalal
- a Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge , MA , USA
| | - Paul J Bröckelmann
- e Department I of Internal Medicine and German Hodgkin Study Group , University Hospital of Cologne , Cologne , Germany
| | - Tim Illidge
- f Institute of Cancer Sciences , University of Manchester, Christie Hospital , Manchester , UK
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28
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Hui L, von Keudell G, Wang R, Zeidan AM, Gore SD, Ma X, Davidoff AJ, Huntington SF. Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer 2017; 123:3763-3771. [PMID: 28640385 PMCID: PMC5610636 DOI: 10.1002/cncr.30818] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent randomized, placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs remain unclear. METHODS A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after ASCT. Life-time costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. RESULTS After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses. CONCLUSIONS BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values. Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:3763-3771. © 2017 American Cancer Society.
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Affiliation(s)
- Lucy Hui
- Yale School of Medicine, New Haven, CT
| | - Gottfried von Keudell
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Steven D. Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amy J. Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
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Abstract
PURPOSE OF REVIEW The treatment of high-risk classic Hodgkin lymphoma (cHL) patients remains challenging, especially after autologous stem cell transplant (ASCT) failure. Moreover, the outcome of chemorefractory patients is still poor. RECENT FINDINGS The development of novel targeted therapies has changed the therapeutic options for high-risk patients. To improve outcome, treatment algorithms should integrate up-front, newly established prognostic markers. Tandem ASCT instead of single ASCT has been proposed as an option to improve outcome for high-risk patients. Availability of less toxic reduced intensity conditioning regimens and recent development in haploidentical transplantation have widened applicability and improved outcomes of allo-hematopoietic cell transplantation. Their exact role in cHL is still controversial and there is no consensus on the optimal transplantation strategy. In this context, results of tandem ASCT should also be compared with those of the autologous/reduced intensity conditioning-allo tandem approach. In this review, we discuss how transplantation strategies (auto and allo) can fit into the salvage treatment plan for patients with relapsed/refractory cHL, taking into account the new drugs available and integrating modern risk assessment. SUMMARY We speculated that improvements could be achieved by transplanting patients in earlier phases of their disease, if necessary after 'bridging' using the new drugs, and we propose an algorithm integrating the different treatment options.
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30
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Karantanos T, Politikos I, Boussiotis VA. Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin's lymphoma with an emphasis on targeted therapies and transplantation strategies. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2017; 7:37-52. [PMID: 28701859 PMCID: PMC5502320 DOI: 10.2147/blctt.s105458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hodgkin’s lymphoma (HL) is highly curable with first-line therapy. However, a minority of patients present with refractory disease or experience relapse after completion of frontline treatment. These patients are treated with salvage chemotherapy followed by autologous stem cell transplantation (ASCT), which remains the standard of care with curative potential for refractory or relapsed HL. Nevertheless, a significant percentage of such patients will progress after ASCT, and allogeneic hematopoietic stem cell transplantation remains the only curative approach in that setting. Recent advances in the pathophysiology of refractory or relapsed HL have provided the rationale for the development of novel targeted therapies with potent anti-HL activity and favorable toxicity profile, in contrast to cytotoxic chemotherapy. Brentuximab vedotin and programmed cell death-1-based immunotherapy have proven efficacy in the management of refractory or relapsed HL, whereas several other agents have shown promise in early clinical trials. Several of these agents are being incorporated with transplantation strategies in order to improve the outcomes of refractory or relapsed HL. In this review we summarize the current knowledge regarding the mechanisms responsible for the development of refractory/relapsed HL and the outcomes with current treatment strategies, with an emphasis on targeted therapies and hematopoietic stem cell transplantation.
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Affiliation(s)
- Theodoros Karantanos
- General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vassiliki A Boussiotis
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Cancer Center, Harvard Medical School, Boston, MA, USA
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31
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Jethava Y, Guru Murthy GS, Hamadani M. Relapse of Hodgkin lymphoma after autologous transplantation: Time to rethink treatment? Hematol Oncol Stem Cell Ther 2017; 10:47-56. [PMID: 28183681 DOI: 10.1016/j.hemonc.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022] Open
Abstract
Relapse of Hodgkin lymphoma after autologous hematopoietic cell transplantation (autologous HCT) is a major therapeutic challenge. Its management, at least in younger patients, traditionally involves salvage chemotherapy aiming to achieve disease remission followed by consolidation with allogeneic hematopoietic cell transplantation (allogeneic HCT) in eligible patients. The efficacy of salvage therapy is variable and newer combination chemotherapy regimens have improved the outcomes. Factors such as shorter time to relapse after autologous HCT and poor performance status have been identified as predictors of poor outcome. Newer agents such as immunoconjugate brentuximab vedotin, checkpoint inhibitors (e.g., pembrolizumab, nivolumab), lenalidomide, and everolimus are available for the treatment of patients relapsing after autologous HCT. With the availability of reduced intensity conditioning allogeneic HCT, more patients are eligible for this therapy with lesser toxicity and better efficacy due to graft versus lymphoma effects. Alternative donor sources such as haploidentical stem cell transplantation and umbilical cord blood transplantation are expanding this procedure to patients without HLA-matched donors. However, strategies aimed at reduction of disease relapse after reduced intensity conditioning allogeneic HCT are needed to improve the outcomes of this treatment. This review summarizes the current data on salvage chemotherapy and HCT strategies used to treat patients with relapsed Hodgkin lymphoma after prior autologous HCT.
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Affiliation(s)
- Yogesh Jethava
- Division of Hematology-Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
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32
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Bröckelmann PJ, Angelopoulou MK, Vassilakopoulos TP. Prognostic factors in Hodgkin lymphoma. Semin Hematol 2016; 53:155-64. [DOI: 10.1053/j.seminhematol.2016.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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33
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Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin's lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC). Bone Marrow Transplant 2016; 51:928-32. [PMID: 27042842 DOI: 10.1038/bmt.2016.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/07/2016] [Accepted: 02/17/2016] [Indexed: 11/09/2022]
Abstract
This report retrospectively analyzed the outcome of 91 patients aged 60 years or older with refractory/relapsed (R/R) classical Hodgkin's lymphoma (cHL) who underwent autologous stem cell transplantation (ASCT) between 1992 and 2013 and were reported to the French Society of Bone Marrow Transplantation and Cell Therapies registry. The median age at transplant was 63 years. The majority of patients exhibited disease chemosensitivity to salvage treatment (57 complete responses, 30 partial responses, 1 progressive disease and 3 unknown). The most frequent conditioning regimen consisted of BCNU, cytarabine, etoposide, melphalan (BEAM) chemotherapy (93%). With a median follow-up of 54 months, 5-year estimates of overall survival (OS) and progression free survival (PFS) for the entire group were 67 and 54%, respectively. Despite the missing data, in univariate analysis, the number of salvage chemotherapy lines (1-2 versus ⩾3) significantly influenced the OS, unlike the other prognostic factors (stage III-IV at relapse, disease status before ASCT and negative positron emission tomography (PET) scan) encountered in younger patients. In spite of its limitations, this retrospective study with a long-term follow-up suggests that ASCT is a valid treatment option for chemosensitive R/R cHL in selected elderly patients, with an acceptable rate of toxicity.
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Adams HJA, Kwee TC. Prognostic value of pretransplant FDG-PET in refractory/relapsed Hodgkin lymphoma treated with autologous stem cell transplantation: systematic review and meta-analysis. Ann Hematol 2016; 95:695-706. [PMID: 26931115 PMCID: PMC4819743 DOI: 10.1007/s00277-016-2619-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/14/2016] [Indexed: 11/29/2022]
Abstract
This study aimed to systematically review the prognostic value of pretransplant 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in refractory/relapsed Hodgkin lymphoma treated with autologous stem cell transplantation (SCT). MEDLINE was systematically searched for appropriate studies. Included studies were methodologically appraised. Results of individual studies were meta-analyzed, if possible. Eleven studies, comprising a total of 745 refractory/relapsed Hodgkin lymphoma patients who underwent FDG-PET before autologous SCT, were included. The overall methodological quality of these studies was moderate. The proportion of pretransplant FDG-PET positive patients ranged between 25 and 65.2 %. Progression-free survival ranged between 0 and 52 % in pretransplant FDG-PET positive patients, and between 55 and 85 % in pretransplant FDG-PET negative patients. Overall survival ranged between 17 and 77 % in pretransplant FDG-PET positive patients, and between 78 and 100 % in FDG-PET negative patients. Based on five studies that provided sufficient data for meta-analysis, pooled sensitivity and specificity of pretransplant FDG-PET in predicting treatment failure (i.e., either progressive, residual, or relapsed disease) were 67.2 % (95 % confidence interval [CI] 58.2–75.3 %) and 70.7 % (95 % CI 64.2–76.5 %), respectively. Based on two studies that provided sufficient data for meta-analysis, pooled sensitivity and specificity of pretransplant FDG-PET in predicting death during follow-up were 74.4 % (95 % CI 58.8–86.5 %) and 58.0 % (95 % CI 49.3–66.3 %), respectively. In conclusion, the moderate quality evidence suggests pretransplant FDG-PET to have value in predicting outcome in refractory/relapsed Hodgkin lymphoma patients treated with autologous SCT. Nevertheless, a considerable proportion of pretransplant FDG-PET positive patients remains disease free and a considerable proportion of pretransplant FDG-PET negative patients develops disease relapse after autologous SCT.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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35
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How I treat relapsed classical Hodgkin lymphoma after autologous stem cell transplant. Blood 2015; 127:287-95. [PMID: 26576863 DOI: 10.1182/blood-2015-10-671826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/16/2015] [Indexed: 12/25/2022] Open
Abstract
Despite the success of standard front-line chemotherapy for classical Hodgkin lymphoma (cHL), a subset of these patients, particularly those with poor prognostic factors at diagnosis (including the presence of B symptoms, bulky disease, advanced stage, or extranodal disease), relapse. For those patients who relapse following autologous stem cell transplant (SCT), multiple treatment options are available, including single-agent chemotherapy, combination chemotherapy strategies, radiotherapy, the immunoconjugate brentuximab, checkpoint inhibitors nivolumab and pembrolizumab, lenalidomide, everolimus, or observation in selected patients. In patients with an available donor, allogeneic SCT may also be considered. With numerous treatment options available, we advocate for a tailored therapeutic approach for patients with relapsed cHL guided by patient-specific characteristics including age, comorbidities, sites of disease (nodal or organ), previous chemosensitivity, and goals of treatment (long-term disease control vs allogeneic SCT).
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A prognostic model predicting autologous transplantation outcomes in children, adolescents and young adults with Hodgkin lymphoma. Bone Marrow Transplant 2015; 50:1416-23. [PMID: 26237164 PMCID: PMC4633349 DOI: 10.1038/bmt.2015.177] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 12/18/2022]
Abstract
Autologous hematopoietic cell transplantation (AutoHCT) is a potentially curative treatment modality for relapsed/refractory Hodgkin lymphoma (HL). However, no large studies have evaluated pre-transplant factors predictive of outcomes of AutoHCT in children, adolescents and young adults (CAYA, age <30 years). In a retrospective study, we analyzed 606 CAYA patients (median age 23 years) with relapsed/refractory HL who underwent AutoHCT between 1995–2010. The probabilities of progression free survival (PFS) at 1, 5 and 10 years were 66% (95% CI: 62–70), 52% (95% CI: 48–57) and 47% (95% CI: 42–51), respectively. Multivariate analysis for PFS demonstrated that at the time of AutoHCT patients with Karnofsky/Lansky score ≥90, no extranodal involvement and chemosensitive disease had significantly improved PFS. Patients with time from diagnosis to first relapse of <1 year had a significantly inferior PFS. A prognostic model for PFS was developed that stratified patients into low, intermediate and high-risk groups, predicting for 5-year PFS probabilities of 72% (95% CI: 64–80), 53% (95% CI: 47–59) and 23% (95% CI: 9–36), respectively. This large study identifies a group of CAYA patients with relapsed/refractory HL who are at high risk for progression after AutoHCT. Such patients should be targeted for novel therapeutic and/or maintenance approaches post-AutoHCT.
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Tonorezos ES, Stillwell EE, Calloway JJ, Glew T, Wessler JD, Rebolledo BJ, Pham A, Steingart RM, Lazarus H, Gale RP, Jakubowski AA, Schaffer WL. Arrhythmias in the setting of hematopoietic cell transplants. Bone Marrow Transplant 2015; 50:1212-6. [PMID: 26030046 PMCID: PMC4558298 DOI: 10.1038/bmt.2015.127] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 03/15/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Abstract
Prior studies report 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients {greater than or equal to}40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 prior to and 61 following transplant. Post-transplant arrhythmias were most frequently atrial fibrillation(N=30), atrial flutter(N=7) and supraventricular tachycardia(N=11). Subjects with an arrhythmia post-transplant were more likely to have longer median hospital stays (32 days vs 23, P=<.001,) a greater probability of an ICU admission (52% vs 7%; P<.001), more inhospital deaths (28% vs 3%, P<0.001), and more deaths within one year of transplant (41% vs 15%; P<0.001) than patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pre-transplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk of death within a year of transplant (OR 3.5, 95% CI: 2.1, 5.9; P < 0.001). Our data suggest arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.
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Affiliation(s)
- E S Tonorezos
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - E E Stillwell
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J J Calloway
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - T Glew
- Department of Medicine, Beth Israel Medical Center, New York, NY, USA
| | - J D Wessler
- Department of Medicine, New York Presbyterian-Columbia, New York, NY, USA
| | - B J Rebolledo
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Pham
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - R M Steingart
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - H Lazarus
- Department of Medicine, UH Case Medical Center, Cleveland, OH, USA
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - A A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - W L Schaffer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Moskowitz CH, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Gianni AM, Carella A, Osmanov D, Bachanova V, Sweetenham J, Sureda A, Huebner D, Sievers EL, Chi A, Larsen EK, Hunder NN, Walewski J. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015; 385:1853-62. [PMID: 25796459 DOI: 10.1016/s0140-6736(15)60165-9] [Citation(s) in RCA: 489] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND High-dose therapy followed by autologous stem-cell transplantation is standard of care for patients with relapsed or primary refractory Hodgkin's lymphoma. Roughly 50% of patients might be cured after autologous stem-cell transplantation; however, most patients with unfavourable risk factors progress after transplantation. We aimed to assess whether brentuximab vedotin improves progression-free survival when given as early consolidation after autologous stem-cell transplantation. METHODS We did this randomised, double-blind, placebo-controlled, phase 3 trial at 78 sites in North America and Europe. Patients with unfavourable-risk relapsed or primary refractory classic Hodgkin's lymphoma who had undergone autologous stem-cell transplantation were randomly assigned, by fixed-block randomisation with a computer-generated random number sequence, to receive 16 cycles of 1·8 mg/kg brentuximab vedotin or placebo intravenously every 3 weeks, starting 30-45 days after transplantation. Randomisation was stratified by best clinical response after completion of salvage chemotherapy (complete response vs partial response vs stable disease) and primary refractory Hodgkin's lymphoma versus relapsed disease less than 12 months after completion of frontline therapy versus relapse 12 months or more after treatment completion. Patients and study investigators were masked to treatment assignment. The primary endpoint was progression-free survival by independent review, defined as the time from randomisation to the first documentation of tumour progression or death. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01100502. FINDINGS Between April 6, 2010, and Sept 21, 2012, we randomly assigned 329 patients to the brentuximab vedotin group (n=165) or the placebo group (n=164). Progression-free survival by independent review was significantly improved in patients in the brentuximab vedotin group compared with those in the placebo group (hazard ratio [HR] 0·57, 95% CI 0·40-0·81; p=0·0013). Median progression-free survival by independent review was 42·9 months (95% CI 30·4-42·9) for patients in the brentuximab vedotin group compared with 24·1 months (11·5-not estimable) for those in the placebo group. We recorded consistent benefit (HR <1) of brentuximab vedotin consolidation across subgroups. The most frequent adverse events in the brentuximab vedotin group were peripheral sensory neuropathy (94 [56%] of 167 patients vs 25 [16%] of 160 patients in the placebo group) and neutropenia (58 [35%] vs 19 [12%] patients). At time of analysis, 28 (17%) of 167 patients had died in the brentuximab vedotin group compared with 25 (16%) of 160 patients in the placebo group. INTERPRETATION Early consolidation with brentuximab vedotin after autologous stem-cell transplantation improved progression-free survival in patients with Hodgkin's lymphoma with risk factors for relapse or progression after transplantation. This treatment provides an important therapeutic option for patients undergoing autologous stem-cell transplantation. FUNDING Seattle Genetics and Takeda Pharmaceuticals International.
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Affiliation(s)
| | | | - Tamas Masszi
- Szent Istvan & Szent Laszlo Corporate Hospital Hematology & Stem Cell Dept, Budapest, Hungary
| | - Edward Agura
- Baylor University Medical Center, Dallas, TX, USA
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | | | - Andy I Chen
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Angelo Carella
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - Dzhelil Osmanov
- Blokhin Cancer Research Center under the Russian Academy of Medical Sciences, Moscow, Russia
| | | | - John Sweetenham
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Sureda
- Institut Catala d'Oncologia-Hospital Duran i Reynals, Barcelona, Spain
| | - Dirk Huebner
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | - Andy Chi
- Takeda Pharmaceuticals International, Cambridge, MA, USA
| | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute and Oncology Center, Warszawa, Poland
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Perales MA, Ceberio I, Armand P, Burns LJ, Chen R, Cole PD, Evens AM, Laport GG, Moskowitz CH, Popat U, Reddy NM, Shea TC, Vose JM, Schriber J, Savani BN, Carpenter PA. Role of cytotoxic therapy with hematopoietic cell transplantation in the treatment of Hodgkin lymphoma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:971-83. [PMID: 25773017 DOI: 10.1016/j.bbmt.2015.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022]
Abstract
The role of hematopoietic cell transplantation (HCT) in the therapy of Hodgkin lymphoma (HL) in pediatric and adult patients is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are included and were reached unanimously by a panel of HL experts. Both autologous and allogeneic HCT offer a survival benefit in selected patients with advanced or relapsed HL and are currently part of standard clinical care. Relapse remains a significant cause of failure after both transplant approaches, and strategies to decrease the risk of relapse remain an important area of investigation.
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Affiliation(s)
- Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Izaskun Ceberio
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Hematology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Philippe Armand
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Linda J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Robert Chen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine and Department of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, New York
| | - Andrew M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Craig H Moskowitz
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Julie M Vose
- Division of Hematology/Oncology, The Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Advance care planning among hematopoietic cell transplant patients and bereaved caregivers. Bone Marrow Transplant 2014; 49:1317-22. [PMID: 25068417 PMCID: PMC4192015 DOI: 10.1038/bmt.2014.152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022]
Abstract
Younger, healthier patients contemplating high-risk (but potentially curative) hematopoietic cell transplants (HCT) may not consider advance care planning (ACP). We investigated the effect of pre-transplant ACP in surviving HCT patients and bereaved caregivers using retrospective, audiotaped telephone surveys. Subjects were identified between 2001–2003 via databases at two high-volume HCT centers. Transcripts were coded by 2 investigators, with differences resolved by consensus. HCT survivors (n=18) were interviewed a median of 13 months after HCT for acute leukemia (7), lymphoma (5), or other (6); 50% had living wills, 72% had a formal proxy. Twelve (67%) had discussed mortality risk pre-HCT with the medical team. Of those, 92% felt their hope and perception of the medical team's truthfulness was increased or unchanged (I/U) by the conversation, while all felt clinician commitment to transplant was I/U. Bereaved caregivers (n=11) were interviewed a median of 10 months post-death (median 31 days post-HCT, range 13–152). Nine (82%) had discussed mortality risk pre-HCT with the medical team; 7 (78%) felt hope was I/U, all felt clinician commitment to transplant and truthfulness was I/U, and most felt ACP reduced burden (67%). ACP discussions with patients and caregivers pre-HCT did not affect hope and supported confidence in medical teams.
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