Clinical outcomes of relapsed and refractory Hodgkin lymphoma patients after contemporary first-line treatment: a German Hodgkin Study Group analysis

• Published in: Leukemia 2022-03, Vol.36 (3), p.772-780
• Main Authors: Bröckelmann, Paul J., Müller, Horst, Gillessen, Sarah, Yang, Xiaoqin, Koeppel, Larissa, Pilz, Veronika, Marinello, Patricia, Kaskel, Peter, Raut, Monika, Fuchs, Michael, Borchmann, Peter, Engert, Andreas, von Tresckow, Bastian
• Format: Article
• Language: English
• Subjects: 631/67/1990/291/1556; 692/699/67/1059/99; Adult; Age; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Cancer Research; Chemotherapy; Clinical outcomes; Clinical trials; Combined Modality Therapy; Critical Care Medicine; Female; Germany - epidemiology; Health risks; Health services; Hematology; Hematopoietic Stem Cell Transplantation; Hodgkin Disease - epidemiology; Hodgkin Disease - therapy; Hodgkin's lymphoma; Humans; Intensive; Internal Medicine; Kaplan-Meier Estimate; Leukemia; Lymphoma; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - therapy; Oncology; Patients; Progression-Free Survival; Radiation therapy; Salvage Therapy; Stem cell transplantation; Stem cells; Subgroups; Survival; Transplantation; Transplantation, Autologous; Treatment Outcome; Young Adult
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-021-01442-8

To evaluate patterns of rrHL after contemporary first-line treatment we studied 409 patients with first rrHL (HD13: n  = 87, HD14: n  = 118, HD15: n  = 188, HDR3i: n  = 51) at a median age of 37.4 years (18.4–76.8) from the GHSG database. Time to first relapse was ≤12 months in 49% and stage III/IV rrHL present in 52% of patients. In total, 291 patients received high-dose chemotherapy and autologous stem-cell transplantation (ASCT) and intended ASCT failed in 38 patients. ASCT was primarily not intended in 80 patients largely due to low risk disease or age/comorbidities. Overall, 10-year progression-free (PFS) and overall survival (OS) rates after first relapse were 48.2% (95% CI 41.9–54.2%) and 59.4% (95% CI 53.0–65.2%), respectively, with significant differences between subgroups. Inferior survival was observed with no ASCT due to advanced age/comorbidities (five-year PFS 36.2%, 95% CI 17.7–55.0%) or failure of salvage therapy (five-year PFS 36.3%, 95% CI 19.7–53.2%). Similarly, presence of primary refractory disease or stage IV at rrHL conferred inferior survival. In patients with low-risk disease, however, survival appeared favorable even without ASCT (10 y PFS 72.6%, 95% CI 53.7–84.8%). We herein confirm the curative potential of current rrHL treatments providing a robust benchmark to evaluate novel therapeutic strategies in rrHL. Approximately 50% of rrHL patients experienced a consecutive relapse.