Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspective

Abstract

Autologous stem cell transplantation (ASCT) is a well-established approach to treatment of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) recommended by both the European Society for Medical Oncology and the National Comprehensive Cancer Network based on the results from randomized controlled studies. However, a considerable number of patients who receive ASCT will progress/relapse and display suboptimal post-transplant outcomes. Over recent years, a number of different strategies have been assessed to improve post-ASCT outcomes and augment HL cure rates. These include use of pre- and post-ASCT salvage therapies and post-ASCT consolidative therapy, with the greatest benefits demonstrated by targeted therapies, such as brentuximab vedotin. However, adoption of these new approaches has been inconsistent across different centers and regions. In this article, we provide a European perspective on the available treatment options and likely future developments in the salvage and consolidation settings, with the aim to improve management of patients with HL who have a high risk of post-ASCT failure. Conclusions We conclude that early intervention with post-ASCT consolidation improves outcomes in patients with R/R HL who require ASCT. Future approvals of targeted agents are expected to further improve outcomes and provide additional treatment options in the coming age of personalized medicine.

Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

“…PN can also be observed in standard HL treatment outside of BV-containing regimens due to other neurotoxic chemotherapy drugs. Initial chemotherapy in a newly diagnosed case of advanced-stage cHL typically involves ABVD (adriamycin, bleomycin, vinblastine plus dacarbazine), BEACOPPescalated (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone, and granulocyte colony-stimulating factor), or Stanford V (doxorubicin, vinblastine, vincristine, bleomycin, etoposide, cyclophosphamide (or mechlorethamine or ifosfamide), prednisone) [ 62 , 63 ]. Paediatric patients often undergo treatment with ABVE-PC (doxorubicin, bleomycin, vinblastine, etoposide, prednisone, cyclophosphamide).…”

“…Importantly, HL is generally a curable haematological malignancy [ 63 ]. Some patients with HL receiving BV will experience persistent or long-term PN.…”

“…In a QoL analysis of the AETHERA study, patients who experienced PN demonstrated lower EuroQol Group European Quality of Life 5-dimensional instrument (EQ-5D scores) than patients in the placebo arm. These were not statistically different and did not reach the MID at any time point [ 137 ], revealing that there were no significant differences in mean EQ-5D scores between patients with and without PN within the BV arm at any time [ 63 ]. Recently, 303 survivors of HL at a median of 16 years after diagnosis with a median follow-up of 16 years reported significantly higher neuropathy symptom burden than controls [ 138 ].…”

Hematopoietic Stem Cell Transplantation for Pediatric Lymphomas

“…Brentuximab vedotin (BV) (anti-CD30) can be used for salvage treatment in R/R patients, as a bridge to transplantation 37 , and as a post transplant maintenance therapy 38 . In a randomized study, a 1year post-transplant maintenance with BV was associated with better disease-free survival (DFS), although no impact on overall survival was observed.…”

Own experience in the treatment of primary refractory Hodgkin's lymphoma. Case report

“…показало, что пациенты с ПЭТ-негативным статусом на момент выполнения ВДХТ с аутоТГСК достигают бессобытийной выживаемости более 80% по сравнению с 29% у ПЭТ-положительных пациентов [17]. Изучается ряд новых стратегий для улучшения результатов ВДХТ и уменьшения токсичности лечения, таких как добавление таргетных препаратов к терапии спасения и применение их в качестве консолидирующей терапии после ВДХТ с аутоТГСК [21].…”