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Mogensen N, Cananau C, Ranta S, Karlén J, Kwiecinska A, Baecklund F. Successful treatment of paediatric refractory Hodgkin lymphoma with immunotherapy - A case report and literature review. Acta Paediatr 2024; 113:1483-1495. [PMID: 38596833 DOI: 10.1111/apa.17235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
AIM To describe a rare case of primary refractory Hodgkin lymphoma nodular sclerosis syncytial variant in a child and review immunotherapy in relapsed/refractory Hodgkin lymphoma. METHODS We described the treatment course of a child with primary refractory classic Hodgkin lymphoma and discussed different options for salvage therapy, with an emphasis on immunotherapy. We searched PubMed for all published clinical trials investigating immunotherapy in classic Hodgkin lymphoma written in English until 31 June, 2023. The reference list of each identified paper was searched for additional publications. RESULTS Our patient was salvaged with anti-programmed cell death 1 (PD-1) antibody therapy followed by high-dose chemotherapy with autologous stem cell rescue. Radiotherapy was avoided. We identified five one-armed phase II trials investigating anti-PD-1 therapy in first relapse/refractory disease in a total of 254 patients aged 9-71 years, of which one included 31 children. The complete remission rate before high-dose chemotherapy was 59%-95% overall and 67%-89% among those with refractory disease. CONCLUSION Although it remains to be proven in randomised trials, anti-PD-1 therapy may provide higher complete response rates than traditional chemotherapy. Anti-PD-1 therapy has the potential to increase the chance of cure while decreasing the risk of late effects from chemotherapy and radiotherapy.
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Affiliation(s)
- Nina Mogensen
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Carmen Cananau
- Department of Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Ranta
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Karlén
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Kwiecinska
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Baecklund
- Paediatric Oncology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Varma G, Diefenbach C. The role of autologous stem-cell transplantation in classical Hodgkin lymphoma in the modern era. Semin Hematol 2024:S0037-1963(24)00080-5. [PMID: 39039012 DOI: 10.1053/j.seminhematol.2024.06.003] [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: 05/07/2024] [Revised: 06/19/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024]
Abstract
Despite excellent cure rates with modern front-line regimens, up to 20% of patients with Hodgkin lymphoma will progress through front-line therapy or experience disease relapse. Worldwide, salvage chemotherapy followed by high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) is considered the standard of care for these patients and can cure approximately 50% of relapsed or refractory (R/R) patients in the second line. Brentuximab vedotin (BV), an anti-CD30 antibody drug conjugate, and PD1 inhibitors like nivolumab and pembrolizumab, have high response rates in patients who recur after HDT/ASCT. When used prior to HDT/ASCT, BV and PD1 inhibitors appear to dramatically increase the effectiveness of salvage therapies with complete response rates often double those seen with historic chemotherapy-based regimens and durable progression free survival (PFS) post-HDT/ASCT. Emerging data in adults and from pediatric trials showing a durable PFS in a subset of relapsed patients raises the question of whether HDT/ASCT is essential for cure in R/R patients after PD1 based salvage. Future studies will help clarify if ASCT can omitted PD1 based salvage to avoid the potential toxicity of HDT/ASCT without compromising cure.
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Affiliation(s)
- Gaurav Varma
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, NY; Division of Hematology and Medical Oncology, NYU Grossman School of Medicine, New York, NY
| | - Catherine Diefenbach
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York, NY; Division of Hematology and Medical Oncology, NYU Grossman School of Medicine, New York, NY.
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3
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Grover NS. The optimal management of relapsed and refractory Hodgkin lymphoma: post-brentuximab and checkpoint inhibitor failure. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:510-518. [PMID: 38066906 PMCID: PMC10727015 DOI: 10.1182/hematology.2023000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The treatment landscape of classical Hodgkin lymphoma has changed dramatically over the past decade. Relapsed and refractory mainstay therapeutics such as brentuximab vedotin (BV) and checkpoint inhibitors (CPIs) are being moved to earlier lines of therapy. However, the treatment of patients who progress after BV and CPI remains a challenge. Allogeneic stem cell transplantation still plays an important role in this patient population as the only current treatment approach with curative potential. Unfortunately, not all patients are transplant candidates, and many will still relapse afterward. Cytotoxic chemotherapy and radiation may be used for symptom palliation or as a bridge to transplant. Targeted therapies, including the antibody drug conjugate, camidanlumab tesirine, and transcriptional agents such mammalian target of rapamycin and histone deacetylase inhibitors have shown some potential in patients with refractory disease. In addition, combination therapies with CPIs and novel agents may help overcome resistance to therapy. Clinical trials with cellular therapies, including chimeric antigen receptor T cells targeting CD30 and allogeneic natural killer cells combined with AFM13, a CD30/CD16a-bispecific antibody, have shown promising results. The availability of more therapeutic options for this patient population is eagerly awaited.
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Affiliation(s)
- Natalie S. Grover
- Division of Hematology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Randall MP, Spinner MA. Optimizing Treatment for Relapsed/Refractory Classic Hodgkin Lymphoma in the Era of Immunotherapy. Cancers (Basel) 2023; 15:4509. [PMID: 37760478 PMCID: PMC10526852 DOI: 10.3390/cancers15184509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Most patients with classic Hodgkin lymphoma (cHL) are cured with combination chemotherapy, but approximately 10-20% will relapse, and another 5-10% will have primary refractory disease. The treatment landscape of relapsed/refractory (R/R) cHL has evolved significantly over the past decade following the approval of brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate, and the PD-1 inhibitors nivolumab and pembrolizumab. These agents have significantly expanded options for salvage therapy prior to autologous hematopoietic cell transplantation (AHCT), post-transplant maintenance, and treatment of relapse after AHCT, which have led to improved survival in the modern era. In this review, we highlight our approach to the management of R/R cHL in 2023 with a focus on choosing first salvage therapy, post-transplant maintenance, and treatment of relapse after AHCT. We also discuss the management of older adults and transplant-ineligible patients, who require a separate approach. Finally, we review novel immunotherapy approaches in clinical trials, including combinations of PD-1 inhibitors with other immune-activating agents as well as novel antibody-drug conjugates, bispecific antibodies, and cellular immunotherapies. Ongoing studies assessing biomarkers of response to immunotherapy and dynamic biomarkers such as circulating tumor DNA may further inform treatment decisions and enable a more personalized approach in the future.
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Affiliation(s)
| | - Michael A. Spinner
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
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Ferhanoglu B, Ozbalak M. Sequencing novel agents in the treatment of classical Hodgkin lymphoma. Expert Rev Hematol 2023; 16:991-1015. [PMID: 37897182 DOI: 10.1080/17474086.2023.2276212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Classical Hodgkin lymphoma (cHL) is a curable disease, with durable remission achieved in about 80% of patients following first-line treatment. Three new drugs were introduced to the daily use in cHL: brentuximab vedotin (BV), nivolumab, and pembrolizumab. All three drugs were initially approved for the treatment of relapsed/refractory cHL (RRHL) and with their promising outcomes, they are now incorporated in different stages of the treatment. AREAS COVERED We performed a literature search using PubMed on all cHL studies investigating BV and CPIs within the past 10 years. We analyzed literature to presume the sequencing of these novel agents. EXPERT OPINION Addition of BV or nivolumab to AVD backbone in the frontline setting showed promising activity in advanced stage cHL. BV and CPIs combined with chemotherapy in the second-line treatment of cHL are evaluated in phase 2 studies and comparable results are reported. The results of BrECADD, with good efficacy and toxicity profile, should be followed. Pembrolizumab was shown to be more effective in RRHL compared to BV in patients who have relapsed post-ASCT or ineligible for ASCT. BV is used in post-ASCT maintenance in high-risk cases, although its role will be questioned as it is increasingly used in the frontline treatment.
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Affiliation(s)
- Burhan Ferhanoglu
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
| | - Murat Ozbalak
- Basaksehir Cam ve Sakura City Hospital, Division of Hematology, Istanbul, Turkey
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Bryan LJ, Casulo C, Allen PB, Smith SE, Savas H, Dillehay GL, Karmali R, Pro B, Kane KL, Bazzi LA, Chmiel JS, Palmer BA, Mehta J, Gordon LI, Winter JN. Pembrolizumab Added to Ifosfamide, Carboplatin, and Etoposide Chemotherapy for Relapsed or Refractory Classic Hodgkin Lymphoma: A Multi-institutional Phase 2 Investigator-Initiated Nonrandomized Clinical Trial. JAMA Oncol 2023; 9:683-691. [PMID: 36928527 PMCID: PMC10020934 DOI: 10.1001/jamaoncol.2022.7975] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/08/2022] [Indexed: 03/17/2023]
Abstract
Importance To our knowledge, this is the first clinical trial designed to investigate concurrent treatment with a checkpoint inhibitor and conventional chemotherapy in relapsed or refractory classic Hodgkin lymphoma in patients destined for an autologous stem cell transplant. Objective To evaluate the complete response rate as assessed by 18F-fluorodeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) after salvage therapy for patients with relapsed or refractory classic Hodgkin lymphoma. Design, Setting, and Participants A single-group, phase 2, multi-institutional nonrandomized clinical trial to evaluate the addition of pembrolizumab to ifosfamide, carboplatin, and etoposide (ICE) chemotherapy was conducted from April 20, 2017, to October 29, 2020, at 5 US sites. The 42 patients were aged 18 years or older, with an Eastern Cooperative Oncology Group Performance Status Scale score of 0 or 1 and biopsy-proven relapsed or refractory classic Hodgkin lymphoma after 1 or 2 prior lines of chemotherapy. Patients were required to be appropriate candidates for transplant, with measurable lesions detected by FDG-PET/CT. Interventions Two cycles of pembrolizumab (200 mg intravenously on day 1) with ICE chemotherapy every 21 days, followed by stem cell mobilization and collection, and then 1 cycle of pembrolizumab monotherapy followed by FDG-PET/CT response assessment. Main Outcomes and Measures The primary end point was complete response rate detected by FDG-PET/CT, defined as a Deauville score of 3 or lower. Patients with a complete response proceeded to an autologous stem cell transplant. Secondary end points included progression-free survival, overall survival, stem cell mobilization, and neutrophil and platelet engraftment. Adverse events were monitored to assess safety. Results Forty-two patients were enrolled, with 37 evaluable for the primary end point. The median age was 34 years (range, 19-70 years), 25 patients were female (68%), 6 were African American (16%), and 26 were White (70%). The complete response rate for the 37 patients assessed by FDG-PET/CT imaging was 86.5% (95% CI, 71.2%-95.5%); the overall response rate was 97.3% (36 patients), with 10.8% partial responses (4 patients). New areas of FDG-PET positivity in 2 patients were biopsied, showing noncaseating granuloma in 1 case and a reactive lymph node in a second. Progression-free survival and overall survival 2-year estimates were 87.2% (32 patients; 95% CI, 77.3%-98.3%) and 95.1% (95% CI, 88.8%-100%), respectively. The addition of pembrolizumab to ICE chemotherapy did not negatively affect stem cell mobilization or collection or engraftment, similar to prior experience in this patient population and setting. Conclusions and Relevance Results suggest that the addition of pembrolizumab to ICE chemotherapy was well tolerated and highly effective in comparison with prior reports of chemotherapy-only regimens, supporting further investigation in patients with relapsed or refractory classic Hodgkin lymphoma eligible for an autologous stem cell transplant. Trial Registration ClinicalTrials.gov Identifier: NCT03077828.
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Affiliation(s)
- Locke J. Bryan
- Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta
| | - Carla Casulo
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Pamela B. Allen
- Division of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Scott E. Smith
- Division of Hematology and Oncology, Loyola University Medical Center, Maywood, Illinois
| | - Hatice Savas
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gary L. Dillehay
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaitlyn L. Kane
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Latifa A. Bazzi
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joan S. Chmiel
- Robert H. Lurie Comprehensive Cancer Center, Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brett A. Palmer
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jayesh Mehta
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Stefoni V, Argnani L, Carella M, Casadei B, Morigi A, Lolli G, Broccoli A, Pellegrini C, Nanni L, Coppola PE, Zinzani PL. BEGEV salvage regimen in relapsed/refractory classical Hodgkin lymphoma: a real-life experience. J Cancer Res Clin Oncol 2023; 149:1043-1047. [PMID: 35239000 PMCID: PMC9984336 DOI: 10.1007/s00432-022-03955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE One of the most critical issues in the management of Hodgkin lymphoma (HL) patients who resulted as primary relapsed or refractory is to obtain a minimal disease status before autologous stem cell transplantation (ASCT). Finding a salvage regimen able to induce this status without severe toxicity would represent a major achievement in this setting. METHODS A single-center retrospective study was conducted to assess effectiveness and safety of BEGEV (bendamustine, gemcitabine, and vinorelbine) regimen as first salvage setting prior to ASCT in HL patients. RESULTS Forty-three patients were treated in our institution between October 2017 and November 2020. Median age at BEGEV therapy was 35.0 years (range 17.2- 70.0), and the median time from frontline therapy to the first cycle of BEGEV was 79.5 days (range 4-2267). At the end of treatment, 31 patients achieved a complete response (CR), with an overall response rate of 76.7%. Forty-one patients harvested CD34+ cells and 35/43 (81.4%) patients underwent ASCT. With a median follow-up of 22 months, 4 CR patients had disease relapse, yielding an estimated disease-free survival of 73.9% at 34 months. The estimated 2-year progression-free survival was 66.7%. Response to first-line chemotherapy did not significantly influence prognosis. CONCLUSIONS BEGEV regimen was well tolerated, and reversible haematological toxic effects were the most common adverse events. Real-life data on BEGEV regimen as first salvage setting showed a relevant rate of objective responses and a limited myelotoxicity with no impairment of a subsequent mobilization of peripheral blood stem cells.
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Affiliation(s)
- Vittorio Stefoni
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Matteo Carella
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Beatrice Casadei
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alice Morigi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Ginevra Lolli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Laura Nanni
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Paolo Elia Coppola
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy. .,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
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8
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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: 1.0] [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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De Re V, Repetto O, Mussolin L, Brisotto G, Elia C, Lopci E, d’Amore ESG, Burnelli R, Mascarin M. Promising drugs and treatment options for pediatric and adolescent patients with Hodgkin lymphoma. Front Cell Dev Biol 2022; 10:965803. [PMID: 36506094 PMCID: PMC9729954 DOI: 10.3389/fcell.2022.965803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Currently-available therapies for newly-diagnosed pediatric and adolescent patients with Hodgkin lymphoma result in >95% survival at 5 years. Long-term survivors may suffer from long-term treatment-related side effects, however, so the past 20 years have seen clinical trials for children and adolescents with HL gradually abandon the regimens used in adults in an effort to improve this situation. Narrower-field radiotherapy can reduce long-term toxicity while maintaining good tumor control. Various risk-adapted chemo-radiotherapy strategies have been used. Early assessment of tumor response with interim positron emission tomography and/or measuring metabolic tumor volume has been used both to limit RT in patients with favorable characteristics and to adopt more aggressive therapies in patients with a poor response. Most classical Hodgkin's lymphoma relapses occur within 3 years of initial treatment, while relapses occurring 5 years or more after diagnosis are rare. As the outcome for patients with relapsed/refractory classical Hodgkin lymphoma remains unsatisfactory, new drugs have been proposed for its prevention or treatment. This review summarizes the important advances made in recent years in the management of pediatric and adolescent with classical Hodgkin lymphoma, and the novel targeted treatments for relapsed and refractory classical Hodgkin lymphoma.
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Affiliation(s)
- Valli De Re
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
| | - Ombretta Repetto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Unit, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Giulia Brisotto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Egesta Lopci
- Nuclear Medicine, IRCCS—Humanitas Research Hospital, Rozzano, MI, Italy
| | | | - Roberta Burnelli
- Pediatric Hematology-Oncology Unit, Azienda Ospedaliera Universitaria, Ospedale Sant’Anna, Ferrara, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
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10
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Zhang XY, Collins GP. Checkpoint Inhibitors and the Changing Face of the Relapsed/Refractory Classical Hodgkin Lymphoma Pathway. Curr Oncol Rep 2022; 24:1477-1488. [PMID: 35696020 PMCID: PMC9606050 DOI: 10.1007/s11912-022-01292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Checkpoint inhibitors (CPIs) targeting PD1 are highly active in relapsed/refractory classical Hodgkin lymphoma. A plethora of recent studies, often small and non-randomised, have raised many questions about how to optimally integrate these into clinical practice. We aim to discuss the use of CPIs in different relapsed/refractory settings in an effort to better define their role and highlight areas of research. RECENT FINDINGS CPIs have shown efficacy at first relapse, as salvage pre- and post-autologous (ASCT) and allogeneic stem cell transplant (alloSCT) and as maintenance post-ASCT. Immune-related adverse events require careful attention, especially when used peri-alloSCT, where it is associated with hyperacute graft-versus-host disease. Newer PD1 inhibitors, as well as strategies to overcome CPI resistance, are being tested. CPIs are increasingly deployed at earlier points in the classical Hodgkin lymphoma pathway. Whilst progress is clearly being made, randomised studies are required to more clearly define the optimal positioning of these agents.
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Affiliation(s)
- Xiao-Yin Zhang
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Department of Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
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Gokmen A, Sahin U, Soydan E, Gokgoz Z, Okcu MK, Ozan U, Arslan O, Ilhan O, Ozcan M. Gemcitabine, Cisplatin, and Dexamethasone as a Salvage and Mobilization Chemotherapy Before Autologous Stem Cell Transplantation is Effective and Safe Outpatient Regimen in Relapsed and Refractory Hodgkin Lymphoma Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e885-e892. [PMID: 35927182 DOI: 10.1016/j.clml.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Second line salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the current standard treatment for eligible patients with relapsed and refractory (R/R) Hodgkin lymphoma (HL). Several salvage regimens have been used before ASCT. However the optimal salvage regimen is still unclear. We report outcome of patients with R/R HL treated with gemcitabine, cisplatin, and dexamethasone (GDP) regimen before ASCT in this retrospective study aiming at evaluating efficacy, stem cell mobilization activity and safety of GDP in a real-life setting. PATIENTS AND METHODS Forty-five patients with R/R HL who were treated with GDP as salvage and mobilization regimen before ASCT were analyzed retrospectively. Peripheral blood stem cells (PBSC) were collected after GDP. All patients underwent ASCT after 2 cycles of GDP. RESULTS Thirty-six (80%) patients achieved overall response including 24 (53.3%) complete response (CR). PBSC collections were adequate in all patients with a median number of 11.01 × 106/kg CD34+ cells. The most common grade 3/4 hematological adverse events were thrombocytopenia (31.1%) and neutropenia (22.2%). There were no febrile neutropenic episodes. Grade 3 or 4 renal, hepatic, or cardiac toxicity was not observed. The 4 year progression-free survival and overall survival for patients receiving GDP followed by ASCT were 72% and 92%, respectively. CONCLUSION Our results suggest that GDP is a viable therapeutic option before ASCT with high response rate, favorable toxicity profile and excellent mobilization potential. Applicability of GDP on an outpatient setting also provides advantage over other effective salvage regimens.
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Affiliation(s)
- Ayla Gokmen
- Department of Hematology, Medicana Bursa Hospital, Bursa, Turkey.
| | - Ugur Sahin
- Department of Hematology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ender Soydan
- Department of Hematology, Guven Hospital, Ankara, Turkey
| | - Zafer Gokgoz
- Department of Hematology, Losante Hospital, Ankara, Turkey
| | - Mevlude Kurdal Okcu
- Department of Hematology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ulku Ozan
- Department of Hematology, Medicana Bursa Hospital, Bursa, Turkey
| | - Onder Arslan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Osman Ilhan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - Muhit Ozcan
- Department of Hematology, Ankara University School of Medicine, Ankara, Turkey
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12
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Takiar R, Karimi Y. Novel Salvage Therapy Options for Initial Treatment of Relapsed/Refractory Classical Hodgkin's Lymphoma: So Many Options, How to Choose? Cancers (Basel) 2022; 14:3526. [PMID: 35884585 PMCID: PMC9318183 DOI: 10.3390/cancers14143526] [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: 03/29/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
The treatment landscape for relapsed/refractory classical Hodgkin's lymphoma (cHL) has evolved with the introduction of several novel agents. Historically, the standard of care for relapsed cHL was salvage chemotherapy followed by autologous stem cell transplant (ASCT). However, many patients are ineligible for ASCT or will have poor responses to salvage chemotherapy and ASCT. Brentuximab vedotin (BV) and checkpoint inhibitors (nivolumab/pembrolizumab) were initially approved in the post-ASCT setting. However, as a result of excellent responses and durable outcomes in this setting, they are now being studied and explored in earlier lines of therapy. Additionally, these agents are also being studied for post-transplant consolidation and maintenance with promising results in improving progression-free survival. We will review current salvage therapy options involving these novel agents and provide comparisons between regimens to aid the clinician in selecting the appropriate salvage regimen for patients who progress after first-line therapy.
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Affiliation(s)
| | - Yasmin Karimi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA;
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13
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Smart salvage treatment for Hodgkin lymphoma. Blood 2022; 139:3563-3564. [PMID: 35737409 DOI: 10.1182/blood.2022016274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
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14
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Nakhoda S, Rizwan F, Vistarop A, Nejati R. Updates in the Role of Checkpoint Inhibitor Immunotherapy in Classical Hodgkin's Lymphoma. Cancers (Basel) 2022; 14:2936. [PMID: 35740598 PMCID: PMC9220999 DOI: 10.3390/cancers14122936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 12/18/2022] Open
Abstract
Classical Hodgkin's lymphoma is a highly curable disease, but 10-25% of patients with higher-risk disease relapse. The introduction of checkpoint inhibitors (CPIs) targeting PD-1 have changed the landscape of treatment for patients with relapsed/refractory disease to multiple lines of therapy. The depth of response to CPI as a monotherapy is highest in the first relapse as salvage therapy based on outcomes reported in several phase II studies. With earlier use of CPI and brentuximab vedotin, the optimal sequencing of therapy is evolving. In this review, we will summarize clinical investigation of anti-PD-1 mAb in earlier line settings to provide insights on utilizing these agents as chemotherapy- and radiation-sparing approaches, increasing depth of response, and as part of combination regimens.
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Affiliation(s)
- Shazia Nakhoda
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (A.V.); (R.N.)
| | - Farsha Rizwan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Aldana Vistarop
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (A.V.); (R.N.)
| | - Reza Nejati
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA; (A.V.); (R.N.)
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15
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Response-adapted anti-PD1 based salvage therapy for Hodgkin lymphoma with nivolumab +/- ICE (NICE). Blood 2022; 139:3605-3616. [PMID: 35316328 DOI: 10.1182/blood.2022015423] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022] Open
Abstract
This phase 2 trial evaluated PET-adapted nivolumab (Nivo) alone or in combination with ifosfamide, carboplatin, and etoposide (NICE) as first salvage therapy and bridge to autologous hematopoietic cell transplantation (AHCT) in relapsed/refractory (RR) classical Hodgkin lymphoma (cHL). Patients with RR cHL received 240mg Nivo every 2 weeks for up to 6 cycles (C). Patients in complete response (CR) after C6 proceeded to AHCT, while patients with progressive disease (PD) at any point or not in CR after C6 received NICE for 2 cycles. The primary endpoint was CR rate per the 2014 Lugano classification at completion of protocol therapy. 43 patients were evaluable for toxicity; 42 were evaluable for response. 34 patients received Nivo alone and 9 patients received Nivo+NICE. No unexpected toxicities were observed after Nivo or NICE. After Nivo, the overall response rate (ORR) was 81% and the CR rate was 71%. Among the 9 patients who received NICE, all responded with 8 (89%) achieving CR. At the end of all protocol therapy, the ORR and CR rates were 93% and 91%. Thirty-three patients were bridged directly to AHCT, including 26 after Nivo alone. The 2-year progression-free survival (PFS) and overall survival in all treated patients (n=43) were 72% (95%CI:56-83) and 95% (95%CI:82-99), respectively. Among the 33 patients who bridged directly to AHCT after protocol therapy, the 2-year PFS was 94% (95%CI:78-98). PET-adapted sequential salvage therapy with Nivo or Nivo+NICE was well-tolerated and effective, resulting in a high CR rate and bridging most patients to AHCT without chemotherapy. This Clinical Trial is registered under NCT03016871.
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16
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Veilleux O, Claveau JS, Alaoui H, Roy J, Ahmad I, Delisle JS, Kiss T, Bambace NM, Bernard L, Cohen S, Sauvageau G, Fleury I, Mollica L, Roy DC, Seroukh Y, Lachance S. Real-world outcomes of autologous and allogeneic hematopoietic stem cell transplantation for relapsed/refractory Hodgkin lymphoma in the era of novel therapies: a Canadian perspective. Transplant Cell Ther 2021; 28:145-151. [PMID: 34954149 DOI: 10.1016/j.jtct.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite high cure rates with frontline therapy for Hodgkin lymphoma (HL), about 30% of patients will relapse or have primary refractory disease (R/r). Autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care for R/r disease and alloHSCT is a curative option for patients in second relapse. Novel agents are being incorporated for the treatment of R/r HL, such that the optimal timing of transplant is currently being challenged. Additionally, because access to these new agents varies amongst transplant centers, we sought to offer a Canadian perspective to the treatment of R/r HL and demonstrate the utility and effectiveness of both AHSCT and alloHSCT for the treatment of R/r HL. METHODS This single-center retrospective study examined outcomes in 89 consecutive patients with R/r HL treated with AHSCT between January 2007 and December 2019. A total of 17 patients underwent alloHSCT either as a tandem auto-allo approach or as salvage therapy. RESULTS With a median follow-up of 5.0 years, the estimated 5-year PFS and OS for patients undergoing AHSCT were 57.5% (95% CI 45.2-68.0) and 81.3% (95% CI 70.0-88.8), respectively. Corresponding figures for patients who underwent alloHSCT were 76.5% (95% CI 48.8-90.4) and 82.4% (95% CI 54.7-93.9). NRM at 100 days and 5 years was 0% and 9.4% post AHSCT and 0% and 5.9% post alloHSCT. Cumulative incidence (CI) of acute GVHD at day +100 was 35.3% (95% CI 17.7 - 62.3) and CI of chronic GVHD at 1 year was 23.5% (95% CI 6.9 - 45.8). CONCLUSIONS AHSCT and alloHSCT can both provide robust and prolonged disease control and new agents should be used as a bridge to improve the curative potential of these definitive cellular therapies.
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Affiliation(s)
- Olivier Veilleux
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Claveau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Habiba Alaoui
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Imran Ahmad
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Delisle
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Thomas Kiss
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Nadia M Bambace
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Léa Bernard
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sandra Cohen
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Guy Sauvageau
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Fleury
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Luigina Mollica
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Denis-Claude Roy
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Yasmina Seroukh
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Lachance
- Hôpital Maisonneuve-Rosemont, Division of Hematology, Medical Oncology and Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
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17
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Epperla N, Hamadani M. Double-refractory Hodgkin lymphoma: tackling relapse after brentuximab vedotin and checkpoint inhibitors. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:247-253. [PMID: 34889401 PMCID: PMC8791097 DOI: 10.1182/hematology.2021000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The approval of brentuximab vedotin (BV) and checkpoint inhibitors (CPI) has revolutionized the management of relapsed/refractory classical Hodgkin lymphoma (cHL) patients. In recent years these agents have rapidly moved to earlier lines of therapy, including post-autologous hematopoietic cell transplant (auto-HCT) consolidation, pre-HCT salvage, and the frontline treatment setting. This shift in practice means that double-refractory (refractory to both BV and CPI) cHL is becoming an increasingly common clinical problem. In patients who are not eligible for clinical trials, conventional cytotoxic and targeted therapies (off label) may be a potential option. In patients who are transplant eligible, early referral to allogeneic HCT should be considered given the significant improvement in transplant outcomes in the contemporary era. Cellular therapy options including CD30.chimeric antigen receptor T cells, Epstein-Barr virus-directed cytotoxic T cells, and CD16A/30 bispecific natural killer cell engagers appear promising and are currently in clinical trials.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, OH
| | - Mehdi Hamadani
- Blood and Marrow Transplant Program and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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18
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Gillessen S, Hüttmann A, Vucinic V, Müller H, Plütschow A, Viardot A, Topp MS, Kobe C, Böll B, Eichenauer DA, Sasse S, Haverkamp H, Schmitz C, Borchmann S, Bröckelmann PJ, Heger JM, Fuchs M, Engert A, Borchmann P, von Tresckow B. Reinduction therapy with everolimus in combination with dexamethasone, high-dose cytarabin and cisplatinum in patients with relapsed or refractory classical Hodgkin lymphoma: an experimental phase I/II multicentre trial of the German Hodgkin Study Group (GHSG HD-R3i). Br J Haematol 2021; 196:606-616. [PMID: 34775591 DOI: 10.1111/bjh.17878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
Reinduction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (HDCT + ASCT) is second-line standard of care for transplant-eligible patients with relapsed/refractory classical Hodgkin lymphoma (r/r cHL) but has a high failure rate. Because response to reinduction is predictive of the outcome after HDCT + ASCT, we aimed to improve the standard dexamethasone, high-dose cytarabine and cisplatinum (DHAP) reinduction regimen by addition of the oral mammalian target of rapamycin inhibitor everolimus (everDHAP). Transplant-eligible patients aged 18-60 years with histologically confirmed r/r cHL were included in this experimental phase I/II trial. Everolimus (10 mg/day, determined in phase-I-part) was administered on day 0-13 of each DHAP cycle. From July 2014 to March 2018, 50 patients were recruited to the phase II everDHAP group; two were not evaluable, three discontinued due to toxicity. Randomization to a placebo group stopped in October 2015 due to poor recruitment after nine patients. The primary end-point of computed tomography (CT)-based complete remission (CR) after two cycles of everDHAP was expected to be ≥40%. With a CT-based CR rate of 27% (n = 12/45) after two cycles of everDHAP the trial did not meet the primary end-point. Adding everolimus to DHAP is thus feasible; however, the everDHAP regimen failed to show an improved efficacy.
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Affiliation(s)
- Sarah Gillessen
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Andreas Hüttmann
- Department of Hematology and Stem Cell Transplantation and Cancer Center Cologne Essen - Partner Site Essen, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vladan Vucinic
- Department of Hematology and Oncology, University of Leipzig, Leipzig, Germany
| | - Horst Müller
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Annette Plütschow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Max S Topp
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG), Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Boris Böll
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Sasse
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Department IV of Internal Medicine, University Hospital Aachen, University of Aachen, Aachen, Germany
| | - Heinz Haverkamp
- Institute for Medical Statistics, Informatics and Epidemiology (IMSIE), University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christine Schmitz
- Department of Hematology and Stem Cell Transplantation and Cancer Center Cologne Essen - Partner Site Essen, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Jan-Michel Heger
- Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Department of Hematology and Stem Cell Transplantation and Cancer Center Cologne Essen - Partner Site Essen, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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19
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Bartlett NL. Optimizing Second-Line Therapy for Hodgkin Lymphoma: A Work in Progress. J Clin Oncol 2021; 39:3097-3103. [PMID: 34428096 DOI: 10.1200/jco.21.01552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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20
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Moskowitz AJ, Shah G, Schöder H, Ganesan N, Drill E, Hancock H, Davey T, Perez L, Ryu S, Sohail S, Santarosa A, Galasso N, Neuman R, Liotta B, Blouin W, Kumar A, Lahoud O, Batlevi CL, Hamlin P, Straus DJ, Rodriguez-Rivera I, Owens C, Caron P, Intlekofer AM, Hamilton A, Horwitz SM, Falchi L, Joffe E, Johnson W, Lee C, Palomba ML, Noy A, Matasar MJ, Pongas G, Salles G, Vardhana S, Sanin BW, von Keudell G, Yahalom J, Dogan A, Zelenetz AD, Moskowitz CH. Phase II Trial of Pembrolizumab Plus Gemcitabine, Vinorelbine, and Liposomal Doxorubicin as Second-Line Therapy for Relapsed or Refractory Classical Hodgkin Lymphoma. J Clin Oncol 2021; 39:3109-3117. [PMID: 34170745 PMCID: PMC9851707 DOI: 10.1200/jco.21.01056] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE We conducted a phase II study evaluating pembrolizumab plus gemcitabine, vinorelbine, and liposomal doxorubicin (pembro-GVD) as second-line therapy for relapsed or refractory (rel/ref) classical Hodgkin lymphoma (cHL) (ClinicalTrials.gov identifier: NCT03618550). METHODS Transplant eligible patients with rel/ref cHL following first-line therapy were treated with two to four cycles of pembrolizumab (200 mg intravenous [IV], day 1), gemcitabine (1,000 mg/m2 IV, days 1 and 8), vinorelbine (20 mg/m2 IV, days 1 and 8), and liposomal doxorubicin (15 mg/m2, days 1 and 8), given on 21-day cycles. The primary end point was complete response (CR) following up to four cycles of pembro-GVD. Patients who achieved CR by labeled fluorodeoxyglucose-positron emission tomography (Deauville ≤ 3) after two or four cycles proceeded to high-dose therapy and autologous hematopoietic cell transplantation (HDT/AHCT). HDT/AHCT was carried out according to institutional standards, and brentuximab vedotin maintenance was allowed following HDT/AHCT. RESULTS Of 39 patients enrolled, 41% had primary ref disease and 38% relapsed within 1 year of frontline treatment. 31 patients received two cycles of pembro-GVD, and eight received four cycles. Most adverse events were grade 1 or two, whereas few were grade 3 and included transaminitis (n = 4), neutropenia (n = 4), mucositis (n = 2), thyroiditis (n = 1), and rash (n = 1). Of 38 evaluable patients, overall and CR rates after pembro-GVD were 100% and 95%, respectively. Thirty-six (95%) patients proceeded to HDT/AHCT, two received pre-HDT/AHCT involved site radiation, and 13 (33%) received post-HDT/AHCT brentuximab vedotin maintenance. All 36 transplanted patients are in remission at a median post-transplant follow-up of 13.5 months (range: 2.66-27.06 months). CONCLUSION Second-line therapy with pembro-GVD is a highly effective and well-tolerated regimen that can efficiently bridge patients with rel/ref cHL to HDT/AHCT.
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Affiliation(s)
- Alison J. Moskowitz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY,Alison J. Moskowitz, MD, Memorial Sloan Kettering Cancer Center, 530 East 74th St, New York, NY 10021; e-mail:
| | - Gunjan Shah
- Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nivetha Ganesan
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Esther Drill
- Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Helen Hancock
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theresa Davey
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie Perez
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sunyoung Ryu
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samia Sohail
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alayna Santarosa
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Natasha Galasso
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rachel Neuman
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brielle Liotta
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Blouin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anita Kumar
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Oscar Lahoud
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Connie L. Batlevi
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Hamlin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Straus
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Colette Owens
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip Caron
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M. Intlekofer
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Audrey Hamilton
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Horwitz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lorenzo Falchi
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erel Joffe
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Johnson
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Lee
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Lia Palomba
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ariela Noy
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J. Matasar
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georgios Pongas
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Gilles Salles
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Santosha Vardhana
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beatriz Wills Sanin
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gottfried von Keudell
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joachim Yahalom
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Dogan
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew D. Zelenetz
- Lymphoma Disease Management Team, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Craig H. Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
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21
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Clinico-Epidemiological Profile, Prognostic Factors and Treatment Outcome of Refractory Hodgkin Lymphoma. Indian J Hematol Blood Transfus 2021; 38:274-281. [PMID: 35496954 PMCID: PMC9001764 DOI: 10.1007/s12288-021-01463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022] Open
Abstract
Approximately 5-10% of patients with Hodgkin lymphoma are refractory to initial treatment. The aim of our study was to assess the clinico-epidemiological profile, prognostic factors and treatment outcome. A retrospective study was conducted over a period of 12 years between June 2006 and January 2018 at the oncology department of Salah Azaïz Institute. Thirty-one patients were included. The median age was 27 years with a female predominance (sex ratio = 0.93).The majority had an advanced stage (61%). IGEV regimen was the most commonly used salvage chemotherapy (n = 14). Age above 30 years was predictive of treatment failure after salvage therapy (p = 0.003). IGEV regimen showed better results than ICE protocol in terms of response to salvage therapy (p = 0.048). Seven patients had salvage radiotherapy. Four patients had autologous stem cell transplant. Progressive disease (n = 12) was the main cause of non-eligibility of autologous stem cell tansplant. Overall survival and progression free survival at 3 years were 50% and 5% respectively. The prognostic factors influencing the overall survival were age above 30 years (p = 0.001), advanced Ann Arbor stage before progression (p = 0.02), advanced Ann Arbor stage of refractory Hodgkin lymphoma (p = 0.001), histological subtype (p = 0.001), CD20 expression (p = 0.027) and non-response to salvage therapy (p = 0.004). The prognostic factor influencing progression free survival was the non-response to salvage therapy (p = 0.045). The prognosis of refractory Hodgkin lymphoma remains poor. The current standard secondary treatment consists of combination therapy, usually followed by autologous stem cell transplantat. Innovative therapies are needed to improve the prognosis of refractory Hodgkin lymphoma. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-021-01463-4.
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22
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How we incorporate novel agents into the treatment of classic Hodgkin lymphoma. Blood 2021; 138:520-530. [PMID: 33889927 DOI: 10.1182/blood.2020007900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/26/2021] [Indexed: 11/20/2022] Open
Abstract
The introduction of targeted immunotherapies specifically, brentuximab vedotin (BV) and programmed death-1 (PD-1) blocking antibodies (nivolumab and pembrolizumab), has reshaped the therapeutic landscape of classic Hodgkin lymphoma (cHL) in the past decade. Targeting specific biologic features of cHL, these novel agents have expanded treatment options for patients with multiply rel/ref cHL and have increasingly been studied at earlier points in a patient's disease course. With the plethora of studies evaluating BV and PD-1 blockade as part of cHL therapy, often in non-randomized, controlled studies, more questions than answers have arisen about how to optimally integrate these drugs into clinical practice. In this article, we use a case-based format to offer practical guidance on how we incorporate BV and anti-PD1 antibodies into the management of cHL and review the data supporting those recommendations.
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23
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Integrating Novel Agents in Relapsed or Refractory Hodgkin Lymphoma: Highlights From SOHO 2020. J Adv Pract Oncol 2021; 12:23-26. [PMID: 33614187 PMCID: PMC7871662 DOI: 10.6004/jadpro.2021.12.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
At the 2020 SOHO Annual Meeting, Alex F. Herrera, MD, of City of Hope, discussed the integration of novel agents into the management of patients with relapsed or refractory Hodgkin lymphoma. Kelly Valla, PharmD, BCOP, of Winship Cancer Institute of Emory University, discusses insights from this session for advanced practitioners.
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24
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Mi M, Zhang C, Liu Z, Wang Y, Li J, Zhang L. Gemcitabine, cisplatin, and dexamethasone and ifosfamide, carboplatin, and etoposide regimens have similar efficacy as salvage treatment for relapsed/refractory aggressive lymphoma: A retrospectively comparative study. Medicine (Baltimore) 2020; 99:e23412. [PMID: 33285732 PMCID: PMC7717738 DOI: 10.1097/md.0000000000023412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In this study, our aim was to compare the efficacy and toxicity profiles of gemcitabine, cisplatin, and dexamethasone (GDP) and ifosfamide, carboplatin, and etoposide (ICE) regimens in the salvage treatment of relapsed/refractory lymphoma. A total of 110 patients with refractory/relapsed classical Hodgkin lymphoma (n = 22) or non-Hodgkin lymphoma (n = 88) who received GDP or ICE salvage regimens from January 2011 to July 2018 were retrospectively analyzed. Of the 110 patients, 50 patients received GDP, and 60 patients received ICE. The response could be evaluated in all patients. In the GDP group, 30 (60.0%) patients achieved overall response rate (ORR), and in the ICE group, the ORR was 56.6%. Of the classical Hodgkin lymphoma patients, the ORR were 72.8% and 54.6% in the GDP and ICE groups, respectively. Of the non-Hodgkin lymphoma patients, the ORR were 56.4% and 57.1% in the GDP and ICE groups, respectively. Grade I-II toxicity occurred in 16 (32.0%) patients in the GDP group and 18 patients (30.0%) in the ICE group; 14 (28.0%) patients had Grade III-IV toxicity in the GDP group, as did 20 (33.3%) patients in the ICE group. As a result, both GDP and ICE regimens are suitable for the treatment of recurrent/refractory lymphoma. The overall adverse reactions of both regimens are acceptable.
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25
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Sureda A, André M, Borchmann P, da Silva MG, Gisselbrecht C, Vassilakopoulos TP, Zinzani PL, Walewski J. Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspective. BMC Cancer 2020; 20:1088. [PMID: 33172440 PMCID: PMC7657361 DOI: 10.1186/s12885-020-07561-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023] Open
Abstract
Autologous stem cell transplantation (ASCT) is a well-established approach to treatment of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) recommended by both the European Society for Medical Oncology and the National Comprehensive Cancer Network based on the results from randomized controlled studies. However, a considerable number of patients who receive ASCT will progress/relapse and display suboptimal post-transplant outcomes. Over recent years, a number of different strategies have been assessed to improve post-ASCT outcomes and augment HL cure rates. These include use of pre- and post-ASCT salvage therapies and post-ASCT consolidative therapy, with the greatest benefits demonstrated by targeted therapies, such as brentuximab vedotin. However, adoption of these new approaches has been inconsistent across different centers and regions. In this article, we provide a European perspective on the available treatment options and likely future developments in the salvage and consolidation settings, with the aim to improve management of patients with HL who have a high risk of post-ASCT failure. CONCLUSIONS: We conclude that early intervention with post-ASCT consolidation improves outcomes in patients with R/R HL who require ASCT. Future approvals of targeted agents are expected to further improve outcomes and provide additional treatment options in the coming age of personalized medicine.
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Affiliation(s)
- Anna Sureda
- Hematology Department, Hematopoietic Stem Cell Transplant Programme, Institut Català d'Oncologia-Hospital Duran i Reynals, Gran Via de l'Hospitalet, 199 - 203, 08908, Barcelona, Spain.
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (UB), Barcelona, Spain.
| | - Marc André
- Department of Hematology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Peter Borchmann
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Maria G da Silva
- Department of Hematology, Instituto Português de Oncologia - Francisco Gentil, Lisbon, Portugal
| | | | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Pier Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italy
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute Oncology Center, Warszawa, Poland
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26
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Castagna L, Santoro A, Carlo-Stella C. Salvage Therapy for Hodgkin's Lymphoma: A Review of Current Regimens and Outcomes. J Blood Med 2020; 11:389-403. [PMID: 33149713 PMCID: PMC7603406 DOI: 10.2147/jbm.s250581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
Relapse/refractory Hodgkin lymphoma patients are still a clinical concern. Indeed, despite more effective first-line chemotherapy regimens and better stratification of unresponsive patients by clinical factors and use of early PET, roughly one-third of such patients need salvage chemotherapy and consolidation with high-dose chemotherapy. In this paper, the authors review the different salvage treatments, with special emphasis on newer combinations with brentuximab vedotin or check point inhibitors. The overall response rate is constantly increasing, with a complete remission rate approaching 80%. Functional response evaluation by PET imaging is a strong predictive factor of longer survival, and more sophisticated tools, such as detection of circulating tumour DNA, are emerging to refine the disease-status assessment after treatment. Consolidation by high-dose chemotherapy is still considered the standard of care in chemosensitive patients, leading to a high fraction of patients towards long-term disease control. Maintenance therapy with BV is now approved, reducing disease relapse/progression. An increasing number of Hodgkin lymphoma patients will be cured after first- and second-line therapy, and long-term toxicity needs to be continuously assessed and avoided.
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Affiliation(s)
- Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.,Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy
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27
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Abstract
Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few malignant cells and numerous immune effector cells in the tumour microenvironment. The incidence of HL is highest in adolescents and young adults, although HL can affect elderly individuals. Diagnosis is based on histological and immunohistochemical analyses of tissue from a lymph node biopsy; the tissue morphology and antigen expression profile enable classification into one of the four types of classic HL (nodular sclerosis, mixed cellularity, lymphocyte-depleted or lymphocyte-rich HL), which account for the majority of cases, or nodular lymphocyte-predominant HL. Although uncommon, HL remains a crucial test case for progress in cancer treatment. HL was among the first systemic neoplasms shown to be curable with radiation therapy and multiagent chemotherapy. The goal of multimodality therapy is to minimize lifelong residual treatment-associated toxicity while maintaining high levels of effectiveness. Recurrent or refractory disease can be effectively treated or cured with high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and prospective trials have demonstrated the potency of immunotherapeutic approaches with antibody-drug conjugates and immune checkpoint inhibitors. This Primer explores the wealth of information that has been assembled to understand HL; these updated observations verify that HL investigation and treatment remain at the leading edge of oncological research.
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28
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Batgi H, Merdin A, Dal MS, Kızıl Çakar M, Yıldız J, Başçı S, Uncu Ulu B, Yiğenoğlu TN, Darçın T, Şahin D, Bakırtaş M, Tetik A, İskender D, Altuntaş F. The effect of gemcitabine, dexamethasone, and cisplatin chemotherapy in relapsed/refractory NHL and HL patients: A single center experience. J Oncol Pharm Pract 2020; 26:1857-1863. [PMID: 32098553 DOI: 10.1177/1078155220905654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The optimal choice of salvage therapy for patients with relapsed/refractory non-Hodgkin lymphoma or Hodgkin lymphoma remains controversial. In this study, we aimed to share our experience in relapsed/refractory lymphoma patients who received GDP/R-GDP as salvage chemotherapy in our center. Data of 47 relapsed/refractory Hodgkin lymphoma and non-Hodgkin lymphoma patients who received GDP or R-GDP as salvage chemotherapy in our center between July 2014 and October 2017 were retrospectively evaluated. Non-Hodgkin lymphoma and Hodgkin lymphoma patients were divided into two groups as primary refractory and relapsed. The one-year overall survival was 100% (for relapsed) and 36.9% (for refractory) in the non-Hodgkin lymphoma groups, and 82.5% (for relapsed) and 80% (for refractory) in the Hodgkin lymphoma group. The one-year progression-free survival (PFS) was 72.7% (for relapsed) and 38.5% (for refractory) in patients with NHL, and 41% (for relapsed) and 18.2% (for refractory) in patients with HL. GDP/R-GDP seems to be a well-tolerated out-patient salvage regimen for relapsed/refractory non-Hodgkin lymphoma and Hodgkin lymphoma. Although proven efficacy, negative toxicity profile, and ease of administration, the application of gemcitabine-based therapy for patients with primary refractory non-Hodgkin lymphoma and Hodgkin lymphoma provided limited success.
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Affiliation(s)
- Hikmettullah Batgi
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Alparslan Merdin
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Merih Kızıl Çakar
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Jale Yıldız
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Semih Başçı
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Bahar Uncu Ulu
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tahir Darçın
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Derya Şahin
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Bakırtaş
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayşegül Tetik
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Dicle İskender
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Fevzi Altuntaş
- Department of Hematology and Stem Cell Transplantation Clinic, Ankara Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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29
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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30
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Daw S, Hasenclever D, Mascarin M, Fernández-Teijeiro A, Balwierz W, Beishuizen A, Burnelli R, Cepelova M, Claviez A, Dieckmann K, Landman-Parker J, Kluge R, Körholz D, Mauz-Körholz C, Wallace WH, Leblanc T. Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group. Hemasphere 2020; 4:e329. [PMID: 32072145 PMCID: PMC7000476 DOI: 10.1097/hs9.0000000000000329] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 01/21/2023] Open
Abstract
The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non-transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus-based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.
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Affiliation(s)
- Stephen Daw
- Children and Young People's Cancer Services, University College Hospital London, London, UK
| | - Dirk Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Ana Fernández-Teijeiro
- Unit of Pediatric Onco-Hematology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Walentyna Balwierz
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Auke Beishuizen
- Prinses Máxima Centrum voor Kinderoncologie, Utrecht, The Netherlands
| | - Roberta Burnelli
- Section of Pediatrics, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Czech Republic
| | - Alexander Claviez
- University Hospital Schleswig Holstein, Department of Pediatric and Adolescent Medicine, Pediatric Hematology, Oncology and Stem Cell Transplantation, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Dieter Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Christine Mauz-Körholz
- Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - Thierry Leblanc
- University of Edinburgh and Department of Pediatrics, Royal Hospital for Sick Children, Edinburgh, Scotland, UK
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31
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Abstract
PURPOSE OF REVIEW The landscape of relapsed or refractory (R/R) Hodgkin lymphoma (HL) treatment has changed significantly since the FDA approval of brentuximab vedotin in 2011. In this review, we summarize the recent advances in the therapy for R/R classical Hodgkin lymphoma (cHL). RECENT FINDINGS Immunotherapies with pembrolizumab, nivolumab, and ipilimumab, and chimeric antigen receptor (CAR) T cell therapies have shown promising results in early phase trials. Other novel agents under investigation include targeted therapies with histone deacetylase inhibitors, Janus kinase 2 inhibitors, and immunomodulators. While further studies with larger populations and longer follow-up times are needed to determine the safe and effective combinations, these novel approaches represent a growing list of treatment options that are on the horizon to improve the cure rate and increase duration of remission for R/R HL patients.
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Affiliation(s)
- Yun Choi
- NYU Langone Hematology & Medical Oncology Fellowship Program, 550 First Avenue, New York, NY, 10016, USA
| | - Catherine S Diefenbach
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, New York University School of Medicine, Langone Medical Center, 240 East 38th Street, 19th Floor, New York, NY, 10016, USA.
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32
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Kulkarni V, Sapkota S, Badarkhe GV, Srinivas BJ, Naik R. Analysis of Relapsed/Refractory Hodgkin Lymphoma Treated with Autologous Transplantation: A Single-Center Experience. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Hodgkin lymphoma (HL) is one of the common lymphomas with high cure rate. Aims: The aim was to study the outcome of relapsed/refractory HL treated with autologous transplantation. Objectives: The objective was to study the overall survival, overall response, and disease-free survival of the relapsed/refractory HL after autologous transplantation. Methods: It was a retrospective study conducted over a period of 8 years in our center using computer-based database and medical records as the data source. Results: A total of 22 patients were diagnosed with relapsed/refractory HL of which majority of cases were male patients (59%) with a mean age of 29 years (range: 15–57 years) and were Stage 4A (40.9%), with nodular sclerosis (54.5%). The overall response rate was 81.8% with 9.1% complete response, 72.7% partial response, and 4.5% stable disease; the overall survival was 77.92 ± 6.65 months, and disease-free survival was 69.66 ± 8.13 months. Conclusion: Autologous stem cell transplant plays an integral role in the treatment of patients with relapsed/refractory Hodgkin lymphoma.
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Affiliation(s)
- Vishal Kulkarni
- Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
| | - Sulav Sapkota
- Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
| | - Girish V Badarkhe
- Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
| | - BJ Srinivas
- Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
| | - Radheshyam Naik
- Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
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Cohen JB, Wei L, Maddocks KJ, Christian B, Heffner LT, Langston AA, Lechowicz MJ, Porcu P, Flowers CR, Devine SM, Blum KA. Gemcitabine and bendamustine is a safe and effective salvage regimen for patients with recurrent/refractory Hodgkin lymphoma: Results of a phase 1/2 study. Cancer 2019; 126:1235-1242. [PMID: 31821549 DOI: 10.1002/cncr.32640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Both gemcitabine and bendamustine have been evaluated in patients with recurrent/refractory Hodgkin lymphoma but to the authors' knowledge not as a doublet. The authors completed a phase 1/2 trial to identify the optimal dose and frequency of administration and to assess the efficacy of this combination in patients with recurrent/refractory Hodgkin lymphoma. METHODS Patients were treated up to a maximum dose of gemcitabine (1000 mg/m2 on day 1) and bendamustine (120 mg/m2 on days 1 and 2), which was determined to be the recommended phase 2 dose, administered every 21 days for up to 6 cycles. Patients could discontinue study therapy after 2 cycles to proceed with autologous or allogeneic stem cell transplantation. RESULTS No dose-limiting toxicities were identified, but 4 patients experienced grade 3 to 5 pulmonary adverse events (toxicity was graded according to Common Terminology Criteria for Adverse Events [version 4]). A total of 26 patients were enrolled having completed a median of 4 prior lines of therapy (range, 1-7 lines), including 13 patients at the recommended phase 2 dose, in whom the overall response rate was 69% and the complete response rate was 46%. The median progression-free survival for the phase 2 patients was 11 months (95% CI, 3 months to not reached), and the median overall survival for this group had not been reached at the time of last follow-up (95% CI, 4 months to not reached). CONCLUSIONS This doublet was found to be tolerable and effective, but patients must be monitored closely for pulmonary toxicity. The authors currently are evaluating this doublet in combination with nivolumab.
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Affiliation(s)
- Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Lai Wei
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Kami J Maddocks
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Beth Christian
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Leonard T Heffner
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amelia A Langston
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Pierluigi Porcu
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Steven M Devine
- Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Kristie A Blum
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Division of Hematology, James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
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Ishizawa K, Yanai T. Hematopoietic Stem Cell Transplantation and Brentuximab Vedotin for Patients with Relapsed or Refractory Hodgkin Lymphoma and Systemic Anaplastic Large-Cell Lymphoma. Adv Ther 2019; 36:2679-2696. [PMID: 31392578 PMCID: PMC6822829 DOI: 10.1007/s12325-019-01046-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Indexed: 02/02/2023]
Abstract
Brentuximab vedotin (BV) is an antibody-drug conjugate that has demonstrated effectiveness as a monotherapy for patients with relapsed or refractory Hodgkin lymphoma and systemic anaplastic large-cell lymphoma via several clinical trials. Salvage chemotherapy followed by autologous or allogeneic hematopoietic stem cell transplantation (HSCT) has been performed as a second- or later-line regimen for improving the survival of patients with lymphoma. In particular, the effectiveness of autologous HSCT and the importance of achieving a complete response prior to autologous HSCT are established in Hodgkin lymphoma. Several clinical trials have reported that salvage chemotherapy followed by autologous HSCT showed high response rates, although significant treatment-related hematological toxicity was observed. In the present article, we review clinical reports for assessing the efficacy and safety of relatively less toxic BV as a bridging therapy before HSCT or as a consolidation therapy post-HSCT in patients with relapsed or refractory Hodgkin lymphoma or systemic anaplastic large-cell lymphoma. Generally, the reported BV regimens seem to be effective and well tolerated in such patients, and no significant influence of BV treatment is noted on hematopoietic stem cell harvest before HSCT. Large-scale clinical studies and long-term follow-up are expected to establish the safety and efficacy of these regimens.Funding: Takeda Pharmaceutical Co., Ltd., Tokyo, Japan.
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Affiliation(s)
- Kenichi Ishizawa
- Division of Hematology and Cell Therapy, Department of Third Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoko Yanai
- Japan Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan.
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Gemcitabine, vinorelbine and dexamethasone: A safe and effective regimen for treatment of relapsed/refractory hodgkin's lymphoma. Leuk Res 2019; 84:106188. [PMID: 31325732 DOI: 10.1016/j.leukres.2019.106188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Salvage regimens in relapsed/refractory Hodgkin's lymphoma (HL) differ in their efficacy and toxicity profiles. Gemcitabine (G), vinorelbine (V) and liposomal doxorubicin (GVDoxil) is one regimen with high response rates but has high toxicity and cost. We devised a regimen of GVDex by substituting the more expensive liposomal doxorubicin with the cheaper high-dose dexamethasone (Dex). PATIENTS AND METHODS We analyzed the data of 48 adult and paediatric patients of relapsed/refractory HL who received GVDex as salvage therapy. GVDex was delivered as outpatient once in 3 weeks (Q3 weekly) (G 1000 mg/m2 IV over 30 min on D1, 8; V 25 mg/m2 IV fast infusion on D1, 8; Dex40 mg PO D1-4) for 2-3 cycles. We present the overall response rate, toxicity, progression-free (PFS) and overall survival (OS) from the time of start of GVDex. RESULTS Forty-eight patients [median age: 24 years (5-63)] received GVDex [(median cycles:3(1-6)] in this period. Median time from diagnosis to the first relapse was 18.9 (2-119) months. Overall response rate [ORR = complete (CR)+partial (PR)] was 63%. Eleven (23%) patients developed febrile neutropenia. After a median follow-up of 20 months, the Kaplan-Meier estimates of patients alive and progression-free at 24 months were 60% and 49%, respectively. CONCLUSIONS The response rates with GVDex were comparable to those reported with GVDoxil when used as a first-line salvage regimen in relapsed/refractory HL. It was an effective regimen even in patients who failed 2 lines of therapy for HL.
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[Novel treatment strategies for relapsed and refractory Hodgkin lymphoma in immunotherapy era]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:348-352. [PMID: 31104453 PMCID: PMC7343006 DOI: 10.3760/cma.j.issn.0253-2727.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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: 3.3] [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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Dahi PB, Moskowitz CH, Giralt SA, Lazarus HM. Novel agents positively impact chemotherapy and transplantation in Hodgkin lymphoma. Expert Rev Hematol 2019; 12:255-264. [PMID: 30874456 DOI: 10.1080/17474086.2019.1593135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Majority of patients with Hodgkin lymphoma (HL) can be successfully cured with frontline conventional therapeutics. Approximately 50-60% of those whose disease recur or is refractory to conventional treatment, can be cured with salvage therapies followed by autologous hematopoietic cell transplantation (AHCT). Conventional treatments, however, may cause significant long-term toxicities. Areas covered: This article reviews the treatment advances in HL with the incorporation of novel and targeted agents that are aimed to improve cure rates while reducing toxicities. Expert opinion: Brentuximab vedotin (BV) and checkpoint inhibitors have demonstrated clear clinical benefit in HL. Majority of patients receive BV before or directly after AHCT as part of salvage or maintenance regimens. In patients who relapse after AHCT, checkpoint inhibitors are the treatment of choice, either as a stand-alone therapy or more commonly as a bridge to a potentially curative allogeneic hematopoietic cell transplantation (alloHCT). A multitude of other targeted agents and combinations, as well as cellular and immunotherapeutic in HL, are under investigation.
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Affiliation(s)
- Parastoo B Dahi
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Craig H Moskowitz
- c Sylvester Comprehensive Cancer Center , University of Miami , Coral Gables , FL , USA
| | - Sergio A Giralt
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Hillard M Lazarus
- d Case Comprehensive Cancer Center , Case Western Reserve University , Cleveland , OH , USA
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Moskowitz AJ. Optimizing the role of brentuximab vedotin in classical Hodgkin lymphoma therapy. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:207-212. [PMID: 30504312 PMCID: PMC6246031 DOI: 10.1182/asheducation-2018.1.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The US Food and Drug Administration approval of brentuximab vedotin (BV) in 2011 marked an important milestone in the management of classical Hodgkin lymphoma (HL). Although initially approved for use in the relapsed or refractory setting, its high efficacy and favorable toxicity profile led to numerous studies evaluating BV in the front-line, second-line, and posttransplant settings. BV is now approved for use (in combination with chemotherapy) as frontline treatment of advanced-stage patients and as maintenance therapy following autologous stem cell transplant. Additional studies demonstrate its promise as second-line therapy and for elderly patients, as well. Although studies have demonstrated its promise in multiple settings, the ideal timing for use of BV is evolving. Studies evaluating individualized treatment strategies will ultimately define the optimal place for BV in HL treatment.
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40
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Broccoli A, Zinzani PL. The role of transplantation in Hodgkin lymphoma. Br J Haematol 2018; 184:93-104. [DOI: 10.1111/bjh.15639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alessandro Broccoli
- Institute of Haematology; “L. e A. Seràgnoli”; University of Bologna; Bologna Italy
| | - Pier Luigi Zinzani
- Institute of Haematology; “L. e A. Seràgnoli”; University of Bologna; Bologna Italy
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Nair R, Kakroo A, Bapna A, Gogia A, Vora A, Pathak A, Korula A, Chakrapani A, Doval D, Prakash G, Biswas G, Menon H, Bhattacharya M, Chandy M, Parihar M, Vamshi Krishna M, Arora N, Gadhyalpatil N, Malhotra P, Narayanan P, Nair R, Basu R, Shah S, Bhave S, Bondarde S, Bhartiya S, Nityanand S, Gujral S, Tilak TVS, Radhakrishnan V. Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group. Indian J Hematol Blood Transfus 2018; 34:398-421. [PMID: 30127547 PMCID: PMC6081314 DOI: 10.1007/s12288-018-0991-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022] Open
Abstract
The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Ajay Bapna
- Bhagwan Mahavir Cancer Hospital Research Center (BMCHRC), Jaipur, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Anu Korula
- Christian Medical College (CMC), Vellore, India
| | | | - Dinesh Doval
- Rajiv Gandhi Cancer Institute and Research Centre (RGCI), New Delhi, Delhi India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ghanashyam Biswas
- Sparsh Hospital American Oncology Institute (AOI), Bhubaneswar, India
| | - Hari Menon
- Cytecare Cancer Hospitals, Bangalore, India
| | | | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Mayur Parihar
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Neeraj Arora
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rekha Nair
- Regional Cancer Centre (RCC), Thiruvananthapuram, India
| | - Rimpa Basu
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Sandip Shah
- Vedant Institute of Medical Sciences, Ahmedabad, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | | | - Soniya Nityanand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | | - Vivek Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
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Herrera AF, Moskowitz AJ, Bartlett NL, Vose JM, Ramchandren R, Feldman TA, LaCasce AS, Ansell SM, Moskowitz CH, Fenton K, Ogden CA, Taft D, Zhang Q, Kato K, Campbell M, Advani RH. Interim results of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory Hodgkin lymphoma. Blood 2018; 131:1183-1194. [PMID: 29229594 PMCID: PMC5855021 DOI: 10.1182/blood-2017-10-811224] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022] Open
Abstract
In this phase 1/2 study, brentuximab vedotin (BV) and nivolumab (Nivo) administered in combination were evaluated as initial salvage therapy in patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (HL). Patients received up to 4 cycles of combination treatment, with BV administered on day 1 and Nivo on day 8 of the first cycle. For cycles 2 to 4, BV and Nivo were both administered on day 1. After study treatment, responses were evaluated by investigators per the 2014 Lugano classification, and patients could proceed to autologous stem cell transplantation (ASCT). Sixty-two patients were enrolled; the complete response rate among all treated patients (n = 61) was 61%, with an objective response rate of 82%. Before ASCT, adverse events (AEs) occurred in 98% of patients, mostly grades 1 and 2. Infusion-related reactions (IRRs) occurred in 44% of patients overall, with 41% of patients experiencing an IRR during at least 1 infusion of BV. Five patients (8%) were treated with systemic steroids for immune-related AEs. A reduction of peripheral T-cell subsets including regulatory T cells was observed after the first dose of BV, and reduced serum levels of thymus- and activation-regulated chemokine concurrent with an increase in proinflammatory cytokines and chemokines were seen after the first BV plus Nivo infusions. The combination of BV plus Nivo was an active and well-tolerated first salvage regimen, potentially providing patients with R/R HL an alternative to traditional chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT02572167.
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Affiliation(s)
| | | | - Nancy L Bartlett
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | | | | | | | - Qu Zhang
- Seattle Genetics, Inc, Bothell, WA
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Herrera AF, Palmer J, Martin P, Armenian S, Tsai NC, Kennedy N, Sahebi F, Cao T, Budde LE, Mei M, Siddiqi T, Popplewell L, Rosen ST, Kwak LW, Nademanee A, Forman SJ, Chen R. Autologous stem-cell transplantation after second-line brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Ann Oncol 2018; 29:724-730. [PMID: 29272364 PMCID: PMC5889038 DOI: 10.1093/annonc/mdx791] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We previously demonstrated that brentuximab vedotin (BV) used as second-line therapy in patients with Hodgkin lymphoma is a tolerable and effective bridge to autologous hematopoietic cell transplantation (AHCT). Here, we report the post-AHCT outcomes of patients treated with second-line standard/fixed-dose BV and an additional cohort of patients where positron-emission tomography adapted dose-escalation of second-line BV was utilized. Patients and methods Patients on the dose-escalation cohort received 1.8 mg/kg of BV intravenously every 3 weeks for two cycles. Patients in complete remission (CR) after two cycles received two additional cycles of BV at 1.8 mg/kg, while patients with stable disease or partial response were escalated to 2.4 mg/kg for two cycles. All patients, regardless of treatment cohort, proceeded directly to AHCT or received additional pre-AHCT therapy at the discretion of the treating physician based on remission status after second-line BV. Results Of the 20 patients enrolled to the BV dose-escalation cohort, 8 patients underwent BV dose-escalation. BV escalation was well-tolerated, but no patients who were escalated converted to CR. Of 56 evaluable patients treated across cohorts, the overall response rate (ORR) to second-line BV was 75% with 43% CR. Twenty-eight (50%) patients proceeded directly to AHCT without post-BV chemotherapy, and a total of 50 patients proceeded to AHCT. Thirteen patients received consolidative post-AHCT therapy with either radiation, BV, or a PD-1 inhibitor. After AHCT, the 2-year progression-free survival (PFS) and overall survival were 67% and 93%, respectively. The 2-year PFS among patients in CR at the time of AHCT (n = 37) was 71% compared with 54% in patients not in CR (p = 0.12). The 2-year PFS in patients who proceeded to AHCT directly after receiving BV alone was 77%. Conclusions Second-line BV is an effective bridge to AHCT that produces responses of sufficient depth to provide durable remission in conjunction with AHCT (clinicaltrials.gov: NCT01393717).
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Affiliation(s)
- A F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - J Palmer
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, USA
| | - P Martin
- Department of Hematology/Oncology, Weill Cornell Medical College, New York, USA
| | - S Armenian
- Department of Population Sciences, City of Hope, Duarte, USA
| | - N-C Tsai
- Department of Information Sciences, Division of Biostatistics, City of Hope, Duarte, USA
| | - N Kennedy
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - F Sahebi
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - T Cao
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - M Mei
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - T Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - S T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - L W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - A Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - S J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA
| | - R Chen
- Department of Hematology and Hematopoietic Cell Transplantation, Division of Biostatistics, City of Hope, Duarte, USA.
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Carras S, Dubois B, Senecal D, Jais JP, Peoc'h M, Quittet P, Foussard C, Bouabdallah K, Gastinne T, Jourdan E, Sanhes L, Ertault M, Lamy T, Molina L. Interim PET Response-adapted Strategy in Untreated Advanced Stage Hodgkin Lymphoma: Results of GOELAMS LH 2007 Phase 2 Multicentric Trial. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:191-198. [PMID: 29502594 DOI: 10.1016/j.clml.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with advanced stage Hodgkin lymphoma still present unsatisfactory outcomes. PATIENTS AND METHODS The Groupe d'étude des Leucémies Aigues et des Maladies du Sang (GOELAMS) group conducted a prospective multicentric trial (NCT00920153) for advanced stage Hodgkin lymphoma to evaluate a positron emission tomography (PET)-adapted strategy. Patients received an intensive regimen (VABEM [vindesine, doxorubicin, carmustine, etoposide, and methylprednisolone]) in front-line and interim 18FFDG-PET evaluation after 2 courses (PET-2). Patients with negative PET-2 findings received 1 additional course. Patients with positive PET-2 findings underwent early salvage therapy followed by high-dose therapy/autologous stem cell transplantation. RESULTS Fifty-one patients were included. The final complete remission rate was 88%. With a median follow up of 5.3 years, 5-year event-free survival and overall survival rates were 75.3% and 85.3%, respectively, for the whole cohort. Patients who were PET-2-negative had 5-year event-free survival and overall survival rates of, respectively, 77.8% and 88.2% versus 85.1% and 91.7% for patients who were PET-2-positive. CONCLUSION A PET-guided strategy with early salvage therapy and high-dose therapy/autologous stem cell transplantation for patients with interim PET-2-positive findings is safe and feasible and provide similar outcome as patients with a negative PET-2.
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Affiliation(s)
- Sylvain Carras
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | - Benjamin Dubois
- Nuclear Medicine Department, Grenoble University Hospital, Grenoble, France
| | | | | | - Michel Peoc'h
- Anatomopathology Department, St Etienne University Hospital, Saint-Etienne, France
| | - Philippe Quittet
- Hematology Department, Montpellier University Hospital, Montpellier, France
| | - Charles Foussard
- Hematology Department, Angers University Hospital, Angers, France
| | | | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Eric Jourdan
- Hematology Department, Nimes University Hospital, Nimes, France
| | - Laurence Sanhes
- Hematology Department, Perpignan Hospital, Perpignan, France
| | - Marjan Ertault
- Hematology Department, Tours University Hospital, Tours, France
| | - Thierry Lamy
- Hematology Department, Rennes University Hospital, Rennes, France
| | - Lysiane Molina
- Hematology Department, Grenoble University Hospital, Grenoble, France
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Bozdağ SC, Yüksel MK, Demirer T. Adult Stem Cells and Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1079:17-36. [DOI: 10.1007/5584_2018_184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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O'Connor OA, Lue JK, Sawas A, Amengual JE, Deng C, Kalac M, Falchi L, Marchi E, Turenne I, Lichtenstein R, Rojas C, Francescone M, Schwartz L, Cheng B, Savage KJ, Villa D, Crump M, Prica A, Kukreti V, Cremers S, Connors JM, Kuruvilla J. Brentuximab vedotin plus bendamustine in relapsed or refractory Hodgkin's lymphoma: an international, multicentre, single-arm, phase 1-2 trial. Lancet Oncol 2017; 19:257-266. [PMID: 29276022 PMCID: PMC9098158 DOI: 10.1016/s1470-2045(17)30912-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/26/2022]
Abstract
Background: The major objective of this study was to explore the safety and clinical activity of Brentuximab vedotin (Bv) and bendamustine in combination in patients with relapsed or refractory Hodgkin Lymphoma. Bv produces high response rates and durable progression-free survival (PFS) in CD30-expressing lymphomas and is approved for the treatment of relapsed Hodgkin lymphoma (HL) and relapsed ALCL. Bendamustine (B) is active agent across the lymphoproliferative malignancies, though the PFS among patients with HL and PTCL is modest. Methods: This was an international, multicenter, single-arm, Phase 1–2 study of BvB in patients with relapsed or refractory HL and ALCL. Eligible patients were required to have relapsed/refractory CD30+ biopsy proven HL or ALCL and an ECOG Performance Status ≤2. In the Phase 1, HL patients were deemed eligible if they developed progressive disease following or after declining ASCT, or had at least 2 prior multi-agent chemotherapy regimens. In the Phase 2, patients with HL were eligible if they had relapsed or refractory disease after one line of therapy. Eligible ALCL patients were required to have relapsed after at least one prior multi-agent chemotherapy regimen and if they were not eligible for or have declined ASCT. The primary objective of the Phase I portion of this study was to identify the maximum tolerated dose (MTD) and dose limiting toxicity (DLT). The primary endpoint of the Phase 2 portion was to determine the overall response rate (ORR; complete response [CR] plus partial response [PR])) based on an intention to treat analysis (ITT). Secondary objectives of Phase 1–2 included assessing for duration of response, progression free survival and overall survival. Response was evaluated using International Harmonization Project Group 2007 Revised Response Criteria. Bv was escalated from 1.2mg/kg Day 1, and B from 70mg/m2 Days 1 and 2 every 21 days until the MTD or recommended phase 2 dose (RP2D) was reached. The study is ongoing but no longer recruiting patients. This trial is registered with ClinicalTrials.gov number NCT01657331. Findings: 65 patients (only 1 ALCL) were treated, 28 on the Phase 1 and 37 on the phase 2. While the MTD of the combination was not reached, the single agent MTD of Bv (1.8mg/kg Day 1) and RP2D of B (90mg/m2 Days 1 and 2) were identified as the RP2D of the combination. Patients were heavily treated, 65% (42 of 65) had an autologous or allogeneic stem cell transplant or both. The Phase 1 revealed modest toxicity. The major Grade 3/4 toxicities included Grade 3 lung infection in 5 (14%) patients in the Phase 2, and Grade 3/4 neutropenia in 13 (24%) patients across the Phase 1 and 2. The Phase 1 and 2 overall response rates (ORR) were 61% and 78% respectively, with 43% (16 of 27) patients treated in the Phase 2 attaining a complete remission (CR). In the Phase 2, the median PFS has not been reached and duration of response (DOR) was 3.4 months. There was a total of 23 deaths with 21 due to progression of disease, 2 occurring after being transplanted, and none of which were treatment related. Interpretation: This demonstrates that BvB might be an effective salvage regimen for patients with HL, with a favorable safety profile. Funding: Seattle Genetics, The Lymphoma Research Fund of Columbia University and National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1TR001873 provided support for this investigator initiated sponsored trial. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Affiliation(s)
- Owen A O'Connor
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA.
| | - Jennifer K Lue
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Ahmed Sawas
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Jennifer E Amengual
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Changchun Deng
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Matko Kalac
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Lorenzo Falchi
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Enrica Marchi
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Ithamar Turenne
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Renee Lichtenstein
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Celeste Rojas
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Mark Francescone
- Department of Radiology, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Lawrence Schwartz
- Department of Radiology, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA; Clinical Translational Research Center, Laboratory of Analytical Pharmacology, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Kerry J Savage
- BC Cancer Agency, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Diego Villa
- BC Cancer Agency, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anca Prica
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Serge Cremers
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA; Clinical Translational Research Center, Laboratory of Analytical Pharmacology, Columbia University Medical Center-College of Physicians and Surgeons, New York, NY, USA
| | - Joseph M Connors
- BC Cancer Agency, Centre for Lymphoid Cancer, Vancouver, BC, Canada
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Nikolaenko L, Chen R, Herrera AF. Current strategies for salvage treatment for relapsed classical Hodgkin lymphoma. Ther Adv Hematol 2017; 8:293-302. [PMID: 29051800 PMCID: PMC5638176 DOI: 10.1177/2040620717728000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022] Open
Abstract
Hodgkin lymphoma (HL) is curable in 70-80% of patients with first-line therapy. However, relapses occur in a minority of patients with favorable early stage disease and are more frequent in patients with advanced HL. Salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) for patients with chemotherapy-sensitive disease is a standard treatment sequence for relapsed or refractory (rel/ref) HL. Patients who achieve complete response prior to ASCT have better survival outcomes. The choice of salvage chemotherapy therapy is becoming increasingly difficult in the era of novel agents, as there are no randomized studies to guide the choice of a second-line regimen. In this article, we will review current salvage therapy options, including combination chemotherapy and novel-agent-based salvage regimens for rel/ref HL.
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Affiliation(s)
- Liana Nikolaenko
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Alex F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
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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: 0.8] [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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Common Chemical Inductors of Replication Stress: Focus on Cell-Based Studies. Biomolecules 2017; 7:biom7010019. [PMID: 28230817 PMCID: PMC5372731 DOI: 10.3390/biom7010019] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/10/2017] [Indexed: 01/01/2023] Open
Abstract
DNA replication is a highly demanding process regarding the energy and material supply and must be precisely regulated, involving multiple cellular feedbacks. The slowing down or stalling of DNA synthesis and/or replication forks is referred to as replication stress (RS). Owing to the complexity and requirements of replication, a plethora of factors may interfere and challenge the genome stability, cell survival or affect the whole organism. This review outlines chemical compounds that are known inducers of RS and commonly used in laboratory research. These compounds act on replication by direct interaction with DNA causing DNA crosslinks and bulky lesions (cisplatin), chemical interference with the metabolism of deoxyribonucleotide triphosphates (hydroxyurea), direct inhibition of the activity of replicative DNA polymerases (aphidicolin) and interference with enzymes dealing with topological DNA stress (camptothecin, etoposide). As a variety of mechanisms can induce RS, the responses of mammalian cells also vary. Here, we review the activity and mechanism of action of these compounds based on recent knowledge, accompanied by examples of induced phenotypes, cellular readouts and commonly used doses.
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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: 0.8] [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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