Improved outcomes of high-risk relapsed Hodgkin lymphoma patients after high-dose chemotherapy: a 15-year analysis

• Published in: Haematologica (Roma) 2022-04, Vol.107 (4), p.899-908
• Main Authors: Nieto, Yago, Gruschkus, Stephen, Valdez, Benigno C, Jones, Roy B, Anderlini, Paolo, Hosing, Chitra, Popat, Uday, Qazilbash, Muzaffar, Kebriaei, Partow, Alousi, Amin, Saini, Neeraj, Srour, Samer, Rezvani, Katayoun, Ramdial, Jeremy, Barnett, Melissa, Gulbis, Alison, Shigle, Terri Lynn, Ahmed, Sairah, Iyer, Swaminathan, Lee, Hun, Nair, Ranjit, Parmar, Simrit, Steiner, Raphael, Dabaja, Bouthaina, Pinnix, Chelsea, Gunther, Jillian, Cuglievan, Branko, Mahadeo, Kris, Khazal, Sajad, Chuang, Hubert, Champlin, Richard, Shpall, Elizabeth J, Andersson, Borje S
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - adverse effects; Brentuximab Vedotin; Hodgkin Disease - diagnosis; Hodgkin Disease - drug therapy; Humans; Neoplasm Recurrence, Local - pathology; Retrospective Studies
• ISSN: 0390-6078; 1592-8721
• DOI: 10.3324/haematol.2021.278311

High-dose chemotherapy and autologous stem-cell transplant (HDC/ASCT) is standard treatment for chemosensitive relapsed classical Hodgkin lymphoma, although outcomes of high-risk relapse (HRR) patients remain suboptimal. We retrospectively analyzed all HRR classical Hodgkin lymphoma patients treated with HDC/ASCT at our institution between 01/01/2005 and 12/31/2019. HRR criteria included primary refractory disease/relapse within 1 year, extranodal extension, B symptoms, requiring more than one salvage line, or positron emission tomography (PET)-positive disease at ASCT. All patients met the same ASCT eligibility criteria. We treated 501 patients with BEAM (n=146), busulphan/melphalan (BuMel) (n=38), gemcitabine( Gem)/BuMel (n=189) and vorinostat/Gem/BuMel (n=128). The Gem/BuMel and vorinostat/Gem/BuMel cohorts had more HRR criteria and more patients with PET-positive disease at ASCT. Treatment with brentuximab vedotin (BV) or anti-PD1 prior to ASCT, PET-negative disease at ASCT, and maintenance BV increased over time. BEAM and BuMel predominated in earlier years (2005-2007), GemBuMel and BEAM in middle years (2008-2015), and vorinostat/GemBuMel and BEAM in later years (2016-2019). The median follow-up is 50 months (range, 6-186). Outcomes improved over time, with 2-year progressionfree survival (PFS)/overall survival (OS) rates of 58%/82% (2005-2007), 59%/83% (2008-2011), 71%/94% (2012-2015) and 86%/99% (2016- 2019) (P