Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation

Kanate, Abraham S.; Kumar, Amit; Dreger, Peter; Dreyling, Martin; Gouill, Steven Le; Corradini, Paolo; Bredeson, Chris; Fenske, Timothy S.; Smith, Sonali M.; Sureda, Anna; Moskowitz, Alison J.; Friedberg, Jonathan W.; Inwards, David J.; Herrera, Alex F.; Kharfan‐Dabaja, Mohamed A.; Reddy, Nishitha; Montoto, Silvia; Robinson, Stephen; Abutalib, Syed Ali; Gisselbrecht, Christian; Vose, Julie M.; Gopal, Ajay K.; Shadman, Mazyar; Perales, Miguel Angel; Carpenter, Paul A.; Savani, Bipin N.; Hamadani, Mehdi

doi:10.1001/jamaoncol.2018.6278

Cited by 48 publications

(29 citation statements)

References 40 publications

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“…While this is an option following ASCT for high-risk disease, as more patients receive BV as part of salvage therapy, the role of BV maintenance may become less clear. An expert panel recently addressed this question with universal support to continue recommending maintenance BV for patients with limited prior BV exposure (~4–6 cycles) who did not have BV refractory disease, grade C recommendation (expert opinion) [ 39 ].…”

Section: Approach To R/r Chl Following Front-line Therapymentioning

confidence: 99%

Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma

Voorhees

Beaven

2020

Cancers

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Hodgkin lymphoma (HL) is a B-cell malignancy representing approximately one in ten lymphomas diagnosed in the United States annually. The majority of patients with HL can be cured with chemotherapy; however, 5–10% will have refractory disease to front-line therapy and 10–30% will relapse. For those with relapsed or refractory (r/r) HL, salvage chemotherapy followed by autologous stem cell transplant (ASCT) is standard of care, but half of patients will subsequently have disease progression. Relapse following ASCT has been associated with exceedingly poor prognosis with a median survival of only 26 months. However, in recent years, novel agents including brentuximab vedotin (BV) and programmed cell death protein 1 monoclonal antibodies (anti-PD-1, nivolumab and pembrolizumab) have been shown to extend overall survival in r/r HL. With the success of novel agents in relapsed disease after ASCT, these therapies are beginning to show clinically meaningful response rates prior to ASCT. Finally, a new investigation in r/r HL continues to produce promising treatment options even after ASCT including CD30 directed chimeric antigen receptor T-cell therapy. In this review, we will discuss the recent advances of BV and anti-PD-1 therapy prior to ASCT, novel approaches in r/r HL after ASCT, and review active clinical trials.

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Section: Approach To R/r Chl Following Front-line Therapymentioning

confidence: 99%

Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma

Voorhees

Beaven

2020

Cancers

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“…[32][33][34][35][36][37] In patients who have received preauto-HCT BV, maintenance BV may be considered if the patient has received ≤ 4-6 cycles and are not resistant or intolerant to BV according to a consensus guideline panel by the ASBMT (now ASTCT), EBMT, and CIBMTR. 42 Data with maintenance PD-1 blockade are promising; however, there is insufficient evidence to support its routine use outside of a clinical trial.…”

Section: Immunotherapymentioning

confidence: 99%

“…45 Consistent with these results, a consensus project between ASTCT, CIBMTR, and the Lymphoma Working Party of EBMT do not recommend rituximab maintenance in DLBCL patients. 42 The evidence supporting post-auto-HCT rituximab maintenance therapy in MCL is stronger. The LYMA trial randomized 240 patients to rituximab maintenance versus observation post-HCT.…”

Section: Immunotherapymentioning

confidence: 99%

“…However, there is no evidence to advise against rituximab maintenance. 42 An ongoing ECOG-ACRIN study is randomizing MRD-negative MCL patients to auto-HCT versus observation, followed by rituximab maintenance therapy, dosed in line with the LYMA study (NCT03267433), to understand the benefit afforded by auto-HCT in MCL patients who reach MRD negative CR.…”

Section: Immunotherapymentioning

confidence: 99%

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Maintenance Strategies After Hematopoietic Cell Transplantation

2020

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Hematopoietic cell transplantation (HCT) is an essential component of potentially curative therapy for patients with hematologic malignancies. High‐dose chemotherapy with autologous (auto) stem cell rescue is used to overcome chemoresistance in multiple myeloma, non‐Hodgkin lymphoma, and Hodgkin lymphoma. Alternatively, poor‐risk acute leukemias rely on the graft versus leukemia effect of allogeneic (allo) products. Long‐term remissions are feasible with both auto‐ and allo‐HCT; however, disease relapse is the leading cause of death after HCT for many patients. In recognition of this, novel therapies are being investigated in the upfront, relapsed/refractory, and post‐HCT maintenance settings to deepen response and maintain disease control. To date, the most robust data to support this approach are in multiple myeloma, where post‐transplant maintenance therapy has improved clinical outcomes. In Hodgkin lymphoma, patients with high‐risk features may benefit from post–auto‐HCT vedotin (BV) regardless of pre‐HCT BV exposure. Apart from mantle cell lymphoma, where rituximab maintenance is generally accepted, post–auto‐HCT maintenance in other forms of NHL is less established. In patients who undergo allo‐HCT, the utilization of maintenance therapy is an important component of improving post‐HCT outcomes, however, an individualized approach that considers patient factors such as residual toxicity from HCT, an immature graft with poor graft function, infection, and graft‐versus‐host disease create a complex environment for aggressive interventions. Initiation of directed agents in patients with identified mutations prior to allo‐HCT, including FLT3 in acute myeloid leukemia and Philadelphia chromosome in acute lymphoid leukemia have generally improved post‐HCT outcomes. Ongoing studies are exploring the safety and efficacy of additional maintenance strategies post–allo‐HCT in an effort to further improve post‐HCT outcomes.

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“…25 An expert panel comprising members of the American Society for Blood and Marrow Transplantation (now called American Society for Transplantation and Cellular Therapy), CIBMTR, and the European Society for Blood and Marrow Transplantation (EBMT) that recently convened to create consensus statements regarding maintenance therapies for HL and NHL endorsed BV maintenance and/or consolidation in BV-naïve high-risk HL. 26 In a recent case study, Flerlage et al 27 described their retrospective review of 5 pediatric patients with R/R HL who received BV post autoHCT. All 5 patients were reported to be alive and in CR with a 29-to 76-month follow-up time from initiation of consolidation.…”

Section: Maintenance After Hctmentioning

confidence: 99%

Hematopoietic Progenitor Cell Transplantation in Children, Adolescents, and Young Adults With Relapsed Mature B-Cell NHL

Gardenswartz¹,

Cairo²

2020

Journal of the National Comprehensive Cancer Network

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Although children, adolescents, and young adults with newly diagnosed B-cell non-Hodgkin’s lymphoma enjoy excellent overall survival with current chemoimmunotherapy, those with relapsed and/or refractory disease have a dismal prognosis. Although most clinicians would agree that hematopoietic progenitor cell transplantation after reinduction therapy is frontline therapy for these patients, there is no consensus as to what type of hematopoietic progenitor cell transplantation promises the best event-free and overall survival. This review outlines the disparate types of stem cell therapy that have been used in this difficult-to-treat population as well as the role of maintenance and CAR T-cell therapy in conjunction with stem cell therapy.

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Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation

Cited by 48 publications

References 40 publications

Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma

Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma

Maintenance Strategies After Hematopoietic Cell Transplantation

Hematopoietic Progenitor Cell Transplantation in Children, Adolescents, and Young Adults With Relapsed Mature B-Cell NHL

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