Brentuximab vedotin in combination with or without donor lymphocyte infusion for patients with Hodgkin lymphoma after allogeneic stem cell transplantation

Abstract

In our study, we evaluated the safety and efficacy of Brentuximab vedotin (BV) with or without the addition of donor lymphocyte infusion (DLI) after allogeneic stem cell transplantation (allo-SCT) in 16 patients with advanced Hodgkin lymphoma (HL). Thirteen patients with relapsed HL after allo-SCT received BV as treatment for active disease. Three patients without progression of HL after allo-SCT received BV as consolidation. Twelve patients had been previously exposed to BV for treatment of relapse after autologous-SCT. Ten out of 16 patients received BV in combination with DLI. Among the 13 patients treated for active disease, CR and PR was observed in 7 and 2 patients, respectively. With a median follow-up of 13 months, 13 out of 16 patients are alive, while 3 died because of disease progression. The median PFS was 6 months. DLI-associated GVHD occurred in seven patients. Five patients with GVHD required immunosuppression, and in all cases, GVHD resolved after a short course of low dose steroids, implying that an anti-GVHD modulating effect could be induced by the concurrent administration of BV. No serious adverse event was observed in any of the patients.

Efficacy and tolerability of nivolumab after allogeneic transplantation for relapsed Hodgkin lymphoma

“…Current strategies for relapsed HL after allo-HCT (summarized in Table 3) are discouraging. [19][20][21][22][23][24][25] Using different approaches (donor lymphocyte infusion with or without chemotherapy, brentuximab vedotin, or bendamustine), modest results were reported, with median PFS ranging from 6 to 18 months. Although our study did not directly compare patients treated with alternative approaches, our results would suggest at least a better risk-benefit ratio than current strategies for relapsed HL after allo-HCT: median PFS was not reached at 16 months alongside an acceptable rate of 30% GVHD and 9 (45%) long-term responders free of cGVHD whereas a majority of long-term responders developed extensive cGVHD after donor lymphocyte infusion-based approaches.…”

Brentuximab vedotin for recurrent Hodgkin lymphoma after allogeneic hematopoietic stem cell transplantation: A report from the EBMT Lymphoma Working Party

“…28 Ten of these patients also received DLI, resulting in GVHD in 7 patients. Unfortunately, we do not know the reason for the higher frequency of DLI in the BV group, but one can speculate that DLI is used for the most part in responding patients after debulking and BV might have been more successful than alternative therapies in this regard.…”

“…16,17,[20][21][22][23] Checkpoint inhibitors are increasingly being used in this setting and appear to be highly efficacious, although with conflicting safety results because they may be complicated by the rapid onset of severe and treatment-refractory graft-versus-host disease (GVHD). 24,25 Anecdotal reports and a few small series have suggested that BV, either alone 26,27 or combined with donor lymphocyte infusion (DLI), 28 may be efficacious in the post-allograft setting.…”

Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin’s lymphoma with an emphasis on targeted therapies and transplantation strategies

“…As an example, brentuximab vedotin has been successfully used prior to allogeneic transplantation 199,200 as a single agent or in combination with DLI for post-alloHCT relapse. 201,202 In contrast, PD-1 blockade prior to or after alloHCT may exacerbate GVHD due to prolonged or permanent inhibition of pathways with a key role in the induction of self-tolerance. 203,204 …”