Brentuximab vedotin as salvage treatment in Hodgkin lymphoma naïve transplant patients or failing ASCT: the real life experience of Rete Ematologica Pugliese (REP)

Abstract

Brentuximab vedotin (BV) shows a high overall response rate (ORR) in relapsed/refractory (R/R) Hodgkin lymphoma (HL) after autologous transplant (ASCT). The aim of this multicenter study, conducted in nine Hematology Departments of Rete Ematologica Pugliese, was to retrospectively evaluate the efficacy and safety of BV as salvage therapy and as bridge regimen to ASCT or allogeneic transplant (alloSCT) in R/R HL patients. Seventy patients received BV. Forty-five patients (64%) were treated with BV as bridge to transplant:16 (23%) patients as bridge to ASCT and 29 (41%) as bridge to alloSCT. Twenty-five patients (36%), not eligible for transplant, received BV as salvage treatment. The ORR was 59% (CR 26%). The ORR in transplant naïve patients was 75% (CR 31%). In patients treated with BV as bridge to alloSCT, the ORR was 62% (CR 24%). In a multivariate analysis, the ORR was lower in refractory patients (p < 0.005). The 2y-OS was 70%. The median PFS was 17 months. Ten of the 16 (63%) naïve-transplant patients received ASCT, with 50% in CR before ASCT. In the 29 patients treated with BV as bridge to alloSCT, 28 (97%) proceeded to alloSCT with 25% in CR prior to alloSCT. The most common adverse events were peripheral neuropathy (50%), neutropenia (29%) and anemia (12%). These data suggest that BV is well tolerated and very effective in R/R HL, producing a substantial level of CR. BV may also be a key therapeutic agent to achieve good disease control before transplant, improving post- transplant outcomes, also in refractory and heavily pretreated patients, without significant overlapping toxicities with prior therapies.

Brentuximab vedotin in relapsed or refractory classical hodgkin lymphoma: real life experience in Norway 2011–2016

“…However responses appear short-lived, and only patients with a CR according to the criteria of the pivotal trial have a realistic chance of long-term survival [5]. Consolidation with a second, mostly allogeneic, SCT is advocated by some authors [13,21,22]. Our data support the use of consolidation and an allogeneic SCT following BV has been used more often since the introduction of BV.…”

“…Observational data also support the use of BV in patients with r/r disease that do not respond adequately to salvage chemotherapy, but would otherwise be suitable for transplant [8,[11][12][13][14][15][16]. Few investigators have reported on the durability of responses thus consolidated.…”

“…Real-world data from different sources support the use of BV in patients with a post-ASCT relapse [6][7][8][9]13]. However responses appear short-lived, and only patients with a CR according to the criteria of the pivotal trial have a realistic chance of long-term survival [5].…”

“…Less data for BV is available in patients ineligible for a first SCT because of an inadequate response to salvage therapy. Early phase I and observational studies demonstrated that BV alone results in OR rates of 40-75% and may allow for a successive SCT in about 30-100% of cases [8,[11][12][13][14][15][16].…”

Current perspectives on the management of refractory or relapsed classic hodgkin lymphoma in brazil: Balancing efficacy, safety, and tolerability

“…Among 29 patients treated with BV as bridge to allogeneic transplantation, overall and CR rates were 62% and 24%, respectively, and 93% of them proceeded to transplantation. This and other real-life studies indicate that BV may allow for disease control before transplantation, potentially improving post-transplantation outcomes, also in refractory and heavily pretreated patients, with acceptable tolerability and no significant overlapping toxicities with prior therapies [88][89][90][91][92].…”