Brentuximab Vedotin-Based Regimens for Older Patients with Newly Diagnosed Classical Hodgkin Lymphoma - International, Multi-Center Real-World Experience

• Published in: Blood 2024-11, Vol.144, p.1668-1668
• Main Authors: Luttwak, Efrat, Kambhampati, Swetha, Drill, Esther, Ganesan, Nivetha, Hofstetter, Liron, Gurion, Ronit, Aumann, Shlomzion, Haran, Arnon, Geva, Mika, Panossian, Marc, Stuver, Robert, Hamlin, Paul A., Noy, Ariela, Herrera, Alex F., Moskowitz, Alison
• Format: Article
• Language: English
• ISSN: 0006-4971
• DOI: 10.1182/blood-2024-212085

Introduction: Despite excellent outcomes for young patients(pts) with HL, pts age 60 have less favorable outcomes with a 5-year PFS of about 60% (Cheng et al. Blood Advances 2022). This disparity is attributed to disease biology factors such as mixed cellularity, EBV positivity, and advanced-stage disease, as well as comorbidities that make patients more vulnerable to treatment toxicity, dose reductions, and interruptions. Brentuximab vedotin (BV) is increasingly used in the front-line setting for older pts. While BV concurrent with AVD (CON) is approved based on ECHELON-1, its use in older pts is limited by toxicity. A phase 2 study (Evens et al., JCO 2018) showed promising results by administering BV sequentially with AVD (SEQ) to improve safety. This study aimed to assess real-world outcomes with BV-based regimens in newly diagnosed older pts with HL. Methods: This retrospective multicenter study was conducted at five medical centers in the US and Israel. Older pts age ≥60 consecutively diagnosed with HL between 03/2013-04/2023 were identified. Data on demographics, comorbidities (including cumulative illness rating scale-geriatrics [CIRS-G] score), AEs, treatment reductions, interruptions, PFS and OS were manually collected from electronic medical records. Results: 136 pts were treated with BV-based regimens. Pt characteristics included a median age of 71 years (range 60-91), 65% male, a median CIRS-G score of 5 (range 0-16), 34% with a history of other malignancy, 54% stage IV disease, 29% with bone marrow involvement, 67% with B symptoms, 46% EBV positive in tumor, and 32% with non-nodular sclerosis histology. Of these pts, 56 (41%) received CON BV-AVD, 54 (40%) were treated with SEQ BV-AVD; the rest (26, 19%) received BV monotherapy or BV-based palliative regimens. Patients treated with CON BV-AVD were younger compared to those treated with SEQ BV-AVD (median 69 vs. 72 years old, p=0.049); Other baseline characteristics did not differ significantly between the two groups. At a median follow up of 2.3 years (range 0.06-10.4), 2-year PFS and OS were 65% (95% CI 56-74%) and 83% (95% CI 76-90%), respectively. After excluding 26 pts treated with palliative regimens, 2-year PFS and OS were 73% (95% CI 64-83%) and 86% (95% CI 80-94%), respectively. We found no significant difference in PFS between SEQ and CON BV-AVD (76% vs. 70% 2-year PFS; p=0.5). In a multivariable Cox regression analysis including age and treatment regimen (SEQ or CON), the regimen was