Current strategies for salvage treatment for relapsed classical Hodgkin lymphoma

Abstract

Hodgkin lymphoma (HL) is curable in 70-80% of patients with first-line therapy. However, relapses occur in a minority of patients with favorable early stage disease and are more frequent in patients with advanced HL. Salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant (ASCT) for patients with chemotherapysensitive disease is a standard treatment sequence for relapsed or refractory (rel/ref) HL. Patients who achieve complete response prior to ASCT have better survival outcomes. The choice of salvage chemotherapy therapy is becoming increasingly difficult in the era of novel agents, as there are no randomized studies to guide the choice of a second-line regimen. In this article, we will review current salvage therapy options, including combination chemotherapy and novel-agent-based salvage regimens for rel/ref HL.

NCCN Guidelines Insights: Hodgkin Lymphoma, Version 1.2018

“…The goal of second-line therapy is to attain a PET-negative CR before HDT/ASCR, 37 because this marker of chemosensitivity is associated with improved outcomes compared with outcomes observed with resistant disease. 38,39 Moskowitz et al 38 reported that EFS, PFS, and OS were significantly better for patients with disease responding to second-line chemotherapy (60%, 62%, and 66%, respectively) compared with those who experienced a poor response (19%, 23%, and 17%, respectively) (P<.001).…”

“…Blockade of the programmed death receptor-1 (PD-1), an immune checkpoint, has demonstrated activity in patients with R/R PD-1-positive lymphomas. [12][13][14]18,37,58 In a phase I study of 23 patients with R/R HL pretreated with both HDT/ASCR and BV, treatment with nivolumab, a PD-1 inhibitor, induced an ORR of 87%, with a PFS rate of 86% at 24 weeks. 12 In a phase II study of 80 patients with R/R HL pretreated with both HDT/ ASCR and BV, treatment with nivolumab induced an objective response in 53 of 80 patients (66.3%; 95% CI, 54.8-76.4), as determined by an independent radiologic review committee, at a median follow-up of 8.9 months.…”

Validation of the RHL30 digital gene expression assay as a prognostic biomarker for relapsed Hodgkin lymphoma

“…The overall role of clinical, radiological and molecular risk factors for cHL continues to evolve and the changing treatment landscape will likely influence the value of previously established biomarkers 10 . For example, the question arises whether brentuximab vedotin maintenance, found to improve progression‐free survival post‐ASCT in the Aethera trial, 11,12 or novel salvage regimens 13,14 obviate the need for prognostic biomarkers. However, patient outcomes are not universally favourable, even with incorporation of novel agents, suggesting that risk scores may play a role to individualize treatment.…”

Hodgkin's lymphoma

“…• Пациентам до 50 лет с рефрактерным течением заболевания (не достигнута ЧР после окончания химиотерапевтического этапа, констатировано прогрессирование), либо с первым ранним рецидивом (продолжительность ремиссии менее 1 года после завершения индукционного лечения), либо в первом позднем рецидиве с большой массой опухоли или во втором позднем рецидиве, не получавшим в первом рецидиве высокодозной ХТ (ВДХТ) с аутоТГСК, если на предшествующих этапах лечения не проводилось облучение поясничного отдела позвоночника, костей таза, и/или не использовались циклы, включающие такие алкилирующие препараты, как мелфалан**# и ломустин**, которым планируется аутоТГСК, рекомендуется проведение ХТ по любой из схем терапии 2-й линии на выбор лечащего врача для определения химиочувствительности опухолевых клеток, уменьшения опухолевой массы и мобилизации стволовых клеток перед этапом ВДХТ [39,40]. УУР C (УДД 5).…”