Brentuximab Vedotin Treatment for Primary Refractory Hodgkin Lymphoma

Abstract

Up to 40% of patients with advanced Hodgkin lymphoma (HL) become refractory or relapsed after current standard chemotherapy, among which primary refractory HL confers a particularly poor outcome. With intensive salvage chemotherapy and autologous stem cell transplantation, the long-term remission rate for these patients was only 30%, but more selective treatments with higher therapeutic index are needed. We report the experience of using a new anti-CD30 immunotoxin, brentuximab vedotin, in salvage treatment of a 30-year-old woman with primary refractory Hodgkin lymphoma. The patient presented with SVC syndrome due to the bulky mediastinal tumor and was confirmed to have classical Hodgkin lymphoma, nodular sclerosis type, stage IIIA. The tumor responded to induction chemotherapy transiently, but local progression was noted during subsequent cycles of treatment. Salvage radiotherapy to the mediastinal tumor, obtained no remission but was followed by rapid in-field progression and then lung metastasis. She declined stem cell transplantation and received salvage brentuximab vedotin (BV) therapy, which induced dramatic shrinkage of tumor without significant side effects. Serial followup of PET/CT imaging confirmed a rapid and continuous complete remission for 12 months. Although durability of the remission needs further observation, this case illustrates the excellent efficacy of brentuximab vedotin in primary refractory Hodgkin lymphoma.

The Role of Brentuximab Vedotin (BV) as Second-Line Treatment of Refractory Classical Hodgkin Lymphoma (cHL) in the Era of Pandemic COVID-19

“… 6 Wu et al reported a case in which BV was a treatment for primary refractory Hodgkin lymphoma. 7 Alessandro et al reported that BV or immune checkpoint inhibitors (every 4 weeks) can be used for relapsed or refractory cHL during the pandemic, 8 and Pietro et al reported that BV as a single agent may be considered as salvage (depending upon accessibility) prior to ASCT, during the COVID-19 pandemic. 9 Another study in Asia reported that BV is a feasible treatment option for R/R Hodgkin Lymphoma with tolerable toxicity in Asian patients, and those who achieved PR could be cured without further transplantation.…”

The Use of Etoposide, Ara-Cytarabine, and Melphalan (EAM) Conditioning Chemotherapy in Autologous Stem Cell Transplantation (ASCT) for a Patient with Relapsed Hodgkin’s Lymphoma

“…For patients who exhibited chemosensitivity, salvage treatment and then high-dose (conditioning) chemotherapy followed by ASCT is the current standard treatment [ 1 , 2 , 6 ]. We followed the methods of Wu et al [ 8 ] utilizing brentuximab vedotin therapy to achieve clinical remission. Related to the conditioning regimen, the two randomized controlled phase III clinical studies with BEAM, mini-BEAM, Dexa-BEAM, or high-dose BEAM found that compared with conventional chemotherapy, salvage high-dose chemotherapy combined with ASCT can significantly increase the disease-free survival (DFS) of relapsed/refractory Hodgkin's lymphoma patients [ 9 , 10 ].…”

The experience of using the Brentuximab vedotin in the treatment of children and young adults with primary refractory course and relapses of Hodgkin's lymphoma

“…В педиатрическую практику при рефрактерных и рецидивных формах ЛХ активно внедряются новые и эффективные методы терапии -иммуноконъюгаты или «checkpoint» ингибиторы, однако оптимальная тактика терапии первично-рефрактерной ЛХ до сих пор не разработана [7].…”