Treating Hodgkin lymphoma in the new millennium: Relapsed and refractory disease

LaCasce, Ann S.

doi:10.1002/hon.2589

Cited by 33 publications

(23 citation statements)

References 21 publications

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“…More than 70% of patients with HL are cured with initial therapy [14,15]. Autologous and AlloSCT may be curative for about half of patients with relapsed disease, but minimal disease burden is generally required to optimize outcomes [16][17][18]. Transplant is less successful for patients whose disease is chemotherapy resistant or multiply relapsed [19].…”

Section: Discussionmentioning

confidence: 99%

“…Transplant is less successful for patients whose disease is chemotherapy resistant or multiply relapsed [19]. Brentuximab vedotin and PD-1 inhibitors have improved outcomes in this setting, but most of these patients will ultimately relapse [18,20,21]. Novel Most patients received standard chemotherapy, targeted therapy, other immunotherapy, or conditioning for SCT.…”

Section: Discussionmentioning

confidence: 99%

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Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

et al. 2020

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Background. Targeted therapies and checkpoint blockade therapy (CBT) have shown efficacy for patients with Hodgkin lymphoma (HL) in the relapsed and refractory (R/R) setting, but once discontinued owing to progression or side effects, it is unclear how successful further therapies will be. Moreover, there are no data on optimal sequencing of these treatments with standard therapies and other novel agents. In a multicenter, retrospective analysis, we investigated whether exposure to CBT could sensitize HL to subsequent therapy. Materials and Methods. Seventeen centers across the U.S. and Canada retrospectively queried medical records for eligible patients. The primary aim was to evaluate the overall response rate (ORR) to post-CBT treatment using the Lugano criteria. Secondary aims included progressionfree survival (PFS), duration of response, and overall survival (OS). Results. Eighty-one patients were included. Seventy-two percent had stage III-IV disease, and the population was heavily pretreated with a median of four therapies before CBT. Most patients (65%) discontinued CBT owing to progression. The ORR to post-CBT therapy was 62%, with a median PFS of 6.3 months and median OS of 21 months. Post-CBT treatment regimens consisted of chemotherapy (44%), targeted agents (19%), immunotherapy (15%), transplant conditioning (14%), chemotherapy/targeted combination (7%), and clinical trials (1%). No significant difference in OS was found when stratified by post-CBT regimen. Conclusion. In a heavily pretreated R/R HL population, CBT may sensitize patients to subsequent treatment, even after progression on CBT. Post-CBT regimen category did not impact OS. This may be a novel treatment strategy, which warrants further investigation in prospective clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

et al. 2020

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“…About one-third of patients with classic Hodgkin lymphoma (cHL) either relapse or are primary refractory to first-line treatment. 1 Disappointingly, the introduction of novel drugs, 2,3 the development of risk-adapted first-line therapy based on fluorodeoxyglucose positron emission tomography (FDG-PET), 4,5 and new scores to predict the risk of progression 6,7 have not significantly modified the rate of treatment failure in relapsed/refractory (RR) patients. 8 Potentially, up to 50% of RR-cHL patients can be cured with a therapeutic strategy based on the achievement of clinical response with a secondline regimen followed by autologous stem cell transplant (ASCT).…”

Section: Introductionmentioning

confidence: 99%

Brentuximab vedotin in association with bendamustine in refractory or multiple relapsed Hodgkin lymphoma. A retrospective real‐world study

Iannitto

Romano

Scalzulli

et al. 2020

European J of Haematology

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Objective and Methods:In order to assess the efficacy of brentuximab vedotin (Bv) in combination with bendamustine (B) in multiple relapsed or refractory (RR) classic Hodgkin lymphoma (cHL), medical records of 47 patients treated with BvB in second relapse or beyond were reviewed. Results:The median number of previous treatments was 2 (1-4). Bv was given at 1.8 mg/kg on day 1 and bendamustine at 90 mg/m 2 on days 1 and 2 of a 21-day cycle. The median number of BvB cycles was 4 (2-7), and all patients were evaluable for efficacy. The CR and OR rates were 49% and 79%, respectively; 67% of responding patients and 2 in stable disease proceeded to a SCT procedure. After a median follow-up of 19 months (5-47), median PFS was 18 months (95%CI: 23-29), and the 2-year OS was 72%. Significantly longer PFS and OS were observed in patients attaining a major clinical response to treatment and in those who received consolidation with SCT. Fifteen (32%) patients experienced severe (G > 2) toxicity. The main toxicities were neutropenia (23%), gastrointestinal (10%), peripheral sensory neuropathy (11%), and infection (4%). Conclusion:Our real-world results suggest that BvB is an effective third-line rescue and bridge-to-transplant regimen for RR-cHL patients.

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“…Hodgkin's lymphoma (HL) is a hematological disease characterized by an excellent long term outcome [1]. However, up to 15% of patients with early stage, and up to 30% of patients with advanced stage HL, are primary refractory or experience recurrence [2]. Therefore, the identification of cases at high risk for first-line therapy failure or recurrence, would significantly impact on HL patient management.…”

Section: Introductionmentioning

confidence: 99%

Methodological framework for radiomics applications in Hodgkin Lymphoma

Sollini

Kirienko

Cavinato

et al. 2020

Preprint

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Background According to published data radiomics features differ between lesions of refractory/relapsing HL patients from those of long-term responders. However, several methodological aspects have not been elucidated yet.Purpose The study aimed at setting up a methodological framework in radiomics applications in Hodgkin Lymphoma (HL), especially at: a) developing a novel feature selection approach; b) evaluating radiomic intra-patient lesions’ similarity; c) classifying relapsing refractory (R/R) vs non-(R/R) patients.Methods We retrospectively included 85 patients (male:female=52:33; median age 35 years, range 19-74). LIFEx (www.lifexsoft.org) was used for [18F]FDG-PET/CT segmentation and feature extraction. Features were a-priori selected if they were highly correlated or uncorrelated to the volume. Principal component analysis-transformed features were used to build the fingerprints, that were tested to assess lesions’ similarity, using the silhouette. For intra-patient similarity analysis, we used patients having multiple lesions only. To classify patients as non-R/R and R/R, the fingerprint considering one single lesion (fingerprint_One) and all lesions (fingerprint_All) was tested using Random Undersamplig Boosting of Tree Ensemble (RUBTE). Results HL fingerprints included up to 15 features. Intra-patient lesion similarity analysis resulted in mean/median silhouette values below 0.5 (low similarity especially in the non-R/R group). In the test set, the fingerprint_One classification accuracy was 62% (78% sensitivity and 53% specificity); the classification by RUBTE using fingerprint_All resulted in 82% accuracy (70% sensitivity and 88% specificity). Conclusions Lesion similarity analysis was developed, and it allowed to demonstrate that HL lesions were not homogeneous within patients in terms of radiomics signature. Therefore, a random target lesion selection should not be adopted for radiomics applications. Moreover, the classifier to predict R/R vs non-R/R, performed the best when all the lesions were used.

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Treating Hodgkin lymphoma in the new millennium: Relapsed and refractory disease

Cited by 33 publications

References 21 publications

Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

Checkpoint Blockade Treatment May Sensitize Hodgkin Lymphoma to Subsequent Therapy

Brentuximab vedotin in association with bendamustine in refractory or multiple relapsed Hodgkin lymphoma. A retrospective real‐world study

Methodological framework for radiomics applications in Hodgkin Lymphoma

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