A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation

Abstract

A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation. Turk J Pediatr 2019; 61: 671-676. Hodgkin's lymphoma (HL) is highly curable disease in its early stages, but in advanced stages, it presents a dilemma when it becomes refractory or relapses after several rounds of chemotherapy. Brentuximab vedotin (BV) is an antibody-drug conjugate that targets the tumor necrosis receptor family protein member CD30 positive malignancies via an anti-CD30 monoclonal antibody linked to monomethyl auristatin-E. In adult and pediatric studies, it has been shown to be an effective salvage therapy for primary refractory HL or relapse after autologous stem cell transplant (ASCT). Between July 2012 and August 2017, we administered BV (1.8 mg/m 2 every three weeks; 12 cycles totally) with doxorubucin, vinblastin, dacarbazine (AVD), rituximab + ifosfamide + carboplatin + etoposide (RICE), or bendamustine combination treatment in pediatric HL patients, who were previosuly treated for refractory or relapsed advanced stage HL before (seven patients) or after (one patient) ASCT in our center. After eight BV courses, one patient was able to undergo match unrelated donor (MUD) SCT. Another seven pediatric HL patients, who were not able to go into remission with any other classical HL chemotherapy protocols, received 4-6 courses of BV-AVD and/or RICE/bendamustine. All were able to undergo ASCT after negative positron emission tomography (PET) imaging results. After ASCT, we switched to BV as consolidation therapy until a total of 12 cycles was completed. Patients went into remission after a median 34 (range: 12-42) months from the start of BV treatment. BV is an encouraging, well-tolerated, and effective targeted therapy especially when combined with AVD or when alternated with another targeted therapy combination, including RICE, when needed.

Real-World Outcomes of Hodgkin Lymphoma: A Multi-Centric Registry From India

“…At relapse, majority of patients (60.0%) received platinum-based salvage chemotherapy. In contrast to Western counterparts (16,40,41), only a very small number of relapsed/refractory (8%) patients received novel agents in salvage setting prior to transplantation, the main reasons being the high cost of newer drugs, an out-of-pocket payment system, and also a sense of nihilism to undergo high-dose chemotherapy and a hematopoietic stem cell transplant (HDCT and HSCT), resulting in only a quarter of patients, responding to salvage, receiving consolidative HDCT and HSCT. This retrospective analysis is the largest Indian dataset specifically looking into the clinical presentation and outcomes in patients with CHL receiving a uniform protocol in the firstline setting.…”

Efficacy of Brentuximab Vedotin and Nivolumab in Refractory or Relapsed Hodgkin Lymphoma: A Systematic Review

“…Salvage chemotherapy with autologous hematopoietic stem cell transplantation is recommended in patients with RRHL. However, due to the associated risks of secondary malignancy and cardiopulmonary toxicity of the procedure, several targeted treatments against CD30 and programmed death (PD) ligands are being evaluated for RRHL [ 9 ]. Normal CD30 expression is restricted to activated B and T cells.…”