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Maranzano M, Mead M. The role of transplantation in Hodgkin lymphoma. Front Oncol 2023; 12:1054314. [PMID: 36776370 PMCID: PMC9908991 DOI: 10.3389/fonc.2022.1054314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023] Open
Abstract
Despite the success of frontline anthracycline-based chemotherapy for classical Hodgkin Lymphoma (cHL), approximately 15% of patients do not achieve an adequate response and require further therapy. For transplant-eligible patients, additional treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autoHCT) provides a durable response in 50% of patients. The most refractory patients, including those requiring multiple lines of therapy to achieve a response or those relapsing after an autoHCT, may achieve long-term survival with allogeneic hematopoietic stem cell transplant (alloHCT). Contemporary salvage regimens used as a bridge to transplant have expanded to include not only non-cross resistant chemotherapy, but also brentuximab vedotin (BV) and checkpoint inhibitors (CPI). As the management of relapsed/refractory (R/R) cHL evolves with the introduction of novel agents, so too does the role of transplantation. The paradigm of chemosensitivity as a predictor for autoHCT efficacy is being challenged by favorable post- autoHCT outcomes in heavily pre-treated CPI-exposed patients. Contemporary supportive care measures, validated comorbidity assessments, and an increased donor pool with haploidentical donors have broadened the application of transplantation to an increasingly older and diverse patient population. Despite the introduction of increasingly effective treatment options for R/R cHL, transplantation continues to play an important role in the management of these patients. In this review, we explore the impact of salvage therapy on autoHCT, conditioning regimens, maintenance therapy and the diminishing role of alloHCT for patients with cHL.
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Affiliation(s)
| | - Monica Mead
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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Velasco R, Domingo-Domenech E, Sureda A. Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy. Cancers (Basel) 2021; 13:6125. [PMID: 34885234 PMCID: PMC8656789 DOI: 10.3390/cancers13236125] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/30/2023] Open
Abstract
Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate approved to treat classical Hodgkin lymphoma (HL). BV-induced peripheral neurotoxicity (BVIN) is one of the greatest concerns for haematologists treating HL for several reasons. First, BVIN is highly frequent. Most patients receiving BV will experience some degree of BVIN, resulting in the primary reason for dose modification or discontinuation of HL therapy. Second, BV produces sensory, motor, and/or autonomic peripheral nerve dysfunction, which can present as severe, disabling forms of BVIN-predominantly motor-in some patients. Third, although largely reversible, BVIN may persist months or years after treatment and thereby become a major issue in HL survivorship. BVIN may, therefore, negatively affect the quality of life and work-life of often young patients with HL, in whom long-term survival is expected. Currently, the only strategy for BVIN includes dose adjustments and treatment discontinuation; however, this could interfere with LH therapy efficacy. In this setting, early recognition and adequate management of BVIN are critical in improving clinical outcomes. Careful neurologic monitoring may allow accurate diagnoses and gradation of ongoing forms of BVIN presentation. This review analysed current, available data on epidemiology, pathophysiology, patient- and treatment-related risk factors, clinical and neurophysiologic phenotypes, and management in patients with HL. Furthermore, this review specifically addresses limitations posed by BVIN assessments in clinical practice and provides skills and tools to improve neurologic assessments in these patients. Integrating this neurotoxic drug in clinical practice requires a multidisciplinary approach to avoid or minimise neurotoxicity burden in survivors of HL.
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Affiliation(s)
- Roser Velasco
- Neuro-Oncology Unit, Department of Neurology, Hospital Universitari de Bellvitge-Institut Català dOncologia, 08908 Barcelona, Spain
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, 08193 Bellaterra, Spain
| | - Eva Domingo-Domenech
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
| | - Anna Sureda
- Department of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, IDIBELL, University of Barcelona (UB), L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (E.D.-D.); (A.S.)
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Mohty R, Dulery R, Bazarbachi AH, Savani M, Hamed RA, Bazarbachi A, Mohty M. Latest advances in the management of classical Hodgkin lymphoma: the era of novel therapies. Blood Cancer J 2021; 11:126. [PMID: 34244478 PMCID: PMC8270913 DOI: 10.1038/s41408-021-00518-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 12/16/2022] Open
Abstract
Hodgkin lymphoma is a highly curable disease. Although most patients achieve complete response following frontline therapy, key unmet clinical needs remain including relapsed/refractory disease, treatment-related morbidity, impaired quality of life and poor outcome in patients older than 60 years. The incorporation of novel therapies, including check point inhibitors and antibody-drug conjugates, into the frontline setting, sequential approaches, and further individualized treatment intensity may address these needs. We summarize the current treatment options for patients with classical Hodgkin lymphoma from frontline therapy to allogeneic hematopoietic stem cell transplantation and describe novel trials in the field.
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Affiliation(s)
- Razan Mohty
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rémy Dulery
- Department of Hematology, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne University, INSERM UMRs 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Abdul Hamid Bazarbachi
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Malvi Savani
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Rama Al Hamed
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ali Bazarbachi
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, AP-HP, Paris, France.
- Sorbonne University, INSERM UMRs 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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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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