Efficacy and safety of bendamustine for the treatment of patients with recurring Hodgkin lymphoma

Abstract

SummaryThe management of patients with Hodgkin lymphoma (HL) recurring after stem cell transplantation (SCT) and multiply relapsed disease remains challenging. We report on 41 such patients who received bendamustine hydrochloride, a bifunctional mechlorethamine derivative mechanistically unrelated to traditional alkylators, after a median of four prior chemotherapy lines, including SCT in 85% of cases. Bendamustine was given at doses of 90-120 mg/m 2 every 21 or 28 d. At first assessment (2-4 cycles), the overall response rate (ORR) was 78% with 12 (29%) complete (CR) and 20 (49%) partial responses (PR). Upon treatment prolongation to 6-8 courses, 40% of PRs progressed, yielding a final ORR of 58% with 31% of CRs. Eight patients (two CRs, six PRs) were subsequently allotransplanted. Median progression-free and overall survival exceeded 11 and 21 months respectively; complete responders displayed a median disease-free survival above 9 months with a relapse rate of only 30%. Outcomes were independent of disease chemosensitivity, previous transplant and bendamustine dose-intensity. No life-threatening or unexpected adverse events occurred.Within the limits of a retrospective analysis and schedule heterogeneity, these results appear very encouraging and prompt prospective trials to confirm bendamustine as a valuable option in the palliative setting and in cytoreductive strategies before allotransplantation.

Sequential combination of gemcitabine, vinorelbine, pegylated liposomal doxorubicin and brentuximab as a bridge regimen to transplant in relapsed or refractory Hodgkin lymphoma

“…Nevertheless, approximately 5-10% of HL patients are refractory to initial treatment and 10-30% relapse after achieving an initial complete remission. In this refractory setting, disease-free survival is very short, [1][2][3][4] even when using an aggressive chemotherapy combination (platinum-based, ifosfamide/etoposide-based). 3,[5][6][7] Owing to these poor results, most experts recommend that eligible patients with relapsed or refractory disease undergo intensive therapy (auto-or allograft) after obtaining a good response.…”

Új lehetőségek a refrakter és relabált Hodgkin-lymphomás betegek kezelésében

“…Hatásme-chanizmusa kettős, mivel apoptózist indukál a p53-dependens alkiláló aktivitásán keresztül, illetve DNS-káro-sító, ami erőteljesebb és hosszabban tartó, mint más alkilálószereké [34]. Relabáló és refrakter HL-ben több vizsgálat igazolta hatékonyságát [35,36,37], a bendamustint 120 mg/m 2 dózisban 2 napig, 28 naponta alkalmazva. Az ORR 53 és 78%, a CR 33 és 29% volt [36,37].…”

“…Relabáló és refrakter HL-ben több vizsgálat igazolta hatékonyságát [35,36,37], a bendamustint 120 mg/m 2 dózisban 2 napig, 28 naponta alkalmazva. Az ORR 53 és 78%, a CR 33 és 29% volt [36,37]. A leggyakoribb grade 3 vagy súlyosabb mellékhatá-sok a thrombocytopenia (20%), az anaemia (14%) és az infekciók (14%) voltak [36].…”

Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all!

“…19 A retrospective study reported an ORR of 78% using bendamustine in relapsed HL. 20 The Memorial Sloan-Kettering Cancer Center group conducted a phase 2 study of bendamustine in 36 (75% had relapsed after a prior auto-HCT) patients with relapsed/refractory HL. 21 The ORR was 53% (CR ¼ 33%).…”