Ifosfamide, gemcitabine, and vinorelbine is an effective salvage regimen with excellent stem cell mobilization in relapsed or refractory pediatric Hodgkin lymphoma

Abstract

We describe 12 pediatric patients (8‐16 years) with primary refractory (N = 6) or first relapse (N = 6) Hodgkin lymphoma (HL) treated with ifosfamide, gemcitabine, and vinorelbine (IGEV). The overall response rate to IGEV was 100%, with seven (58%) complete responses (CR) and five (42%) partial responses. Successful CD34+ stem cell mobilization was achieved in all patients. Following subsequent autologous stem cell transplantation, 10 patients (83%) achieved CR. At a median follow‐up of 71 months, 11 patients had no evidence of disease. Five‐year second event‐free survival and overall survival were 83% ± 11.0% and 90.0% ± 9.5%, respectively. IGEV is an effective salvage regimen for children with relapsed/refractory HL.

Pediatric Hodgkin Lymphoma, Version 3.2021

“…66 In a study of 12 pediatric patients with primary refractory or relapsed HL (age range, 8-16 years), the ORR to IGEV was 100%, with 58% CRs and 42% PRs. 67 The 5-year second EFS and OS rates were 83.0% ± 11.0% and 90.0% ± 9.5%, respectively. 67 4) Targeted therapy and immunotherapy-based regimens include brentuximab vedotin combined with bendamustine, 68 gemcitabine, 69 or nivolumab 70 ; or single-agent nivolumab 71,72 or single-agent pembrolizumab.…”

Brentuximab vedotin in combination with bendamustine in pediatric patients or young adults with relapsed or refractory Hodgkin lymphoma

“…42 Rescue regimens such as gemcitabine/vinorelbine, ifosfamide/ vinorelbine ± bortezomib in adult and pediatric patients were published, showing complete metabolic response rates superimposable to more traditional regimens with OS in the order of 80% and EFS of 70% with inferior toxicities. 11,13,43,44 More recently, chemotherapy has been combined with immunotherapy in both pediatric and adult settings. The Children's Oncology Group published a multicenter, single-arm, phases 1-2 trial testing the recommended dose of BV (1.4 and 1.8 mg/kg) in combination with gemcitabine (1000 mg/m 2 on days 1 and 8) (NCT01780662).…”

“…The EuroNet Pediatric Hodgkin Lymphoma group has published a consensus‐based guideline for salvage treatment 42 . Rescue regimens such as gemcitabine/vinorelbine, ifosfamide/vinorelbine ± bortezomib in adult and pediatric patients were published, showing complete metabolic response rates superimposable to more traditional regimens with OS in the order of 80% and EFS of 70% with inferior toxicities 11,13,43,44 . More recently, chemotherapy has been combined with immunotherapy in both pediatric and adult settings.…”

“…The standard of care for this subgroup is salvage chemotherapy, followed by autologous hematopoietic stem cell transplantation (HSCT) 10 . Complete remission (CR) rates after salvage chemotherapy range from 25% to 60% in the first relapse setting 11–16 . Improved outcomes have been reported for patients who achieve CR before autologous HSCT, while prognosis is extremely poor in case of relapse or progressive disease (PD) within 1 year following autologous HSCT 17,18 .…”

Predictive value of interim and post-treatment PET/CT for clinical evaluation in pediatric and adolescent Hodgkin lymphoma: A comparison of the Deauville Criteria and the International Harmonization Project Criteria

“…Exclusion criteria: (1) Patients who were adults or diagnosed with other types of lymphoma, patients without baseline or post-treatment PET/CT scans, (2)Patients with refractory HL defined as progression or new lesions on PET/CT within three months of first-line treatment 20 . Patients without interim PET/CT, for example, whose PET/CT was performed after 4-6 cycles of chemotherapy, were also excluded.…”