Outcome of High-Dose Chemotherapy Followed by Autologous Stem Cell Transplantation in Relapsed/Refractory Hodgkin Lymphoma after Different Numbers of Salvage Regimens

Abstract

The introduction of novel drugs (PD-1 inhibitors and/or brentuximab vedotin) into salvage regimens has improved the response rate and the outcome of patients with relapsed/refractory Hodgkin lymphoma. However, the impact of new drugs on the outcome has not been adequately investigated so far. We retrospectively analyzed 42 consecutive patients treated at our institution with high-dose chemotherapy/autologous stem cell transplantation after either one standard chemotherapy represented by BEGEV (n = 28) or >1 salvage therapy (ST) comprising novel drugs (n = 14). With a median follow-up of 24 months, the 2-year cumulative incidence of relapse was similar between the two cohorts: 26% for 1 ST and 18% for >1 ST (p = 0.822). Consistently, overall survival and progression-free survival did not differ among the two groups: 3-year overall survival was 91% and 89% (p = 0.731), respectively, and 3-year progression-free survival was 74% and 83% (p = 0.822) for only one and more than one salvage regimens, respectively. Of note, the post-transplant side effects and engraftment rates were similar between the 1 ST and >1 ST cohorts. In conclusion, consolidation with high-dose chemotherapy/autologous stem cell transplantation is a safe and curative option, even for patients achieving disease response after more than one rescue line of therapy.

Keywords: Hodgkin lymphoma; new drugs; transplantation.

Figure 1

Treatment schedule before HDT/ASCT. Detailed sequence of salvage treatments performed in patients with Rel or Ref Hodgkin lymphoma. The one-salvage-line cohort received only chemotherapy consisting of BEGEV or IGEV. The >1 salvage line group received, besides chemotherapy, new target therapy drugs (BV or Pembro) as rescue before autologous stem cell transplantation (ASCT). ABVD: adriamycin, bleomycin, vinblastine, dacarbazine; ASCT: autologous stem cell transplantation; BEACOPP: doxorubicin, cyclophosphamide, etoposide, procarbazine, prednisolone, vincristine, bleomycin; BEGEV: bendamustin, gemcitabine, vinblastine; BV: brentuximab vedotin; IGEV: ifosfamide, etoposide, vinblastine; VACOP: doxorubicin, cyclophosphamide, etoposide, prednisolone, vincristine, bleomycin; Pembro: pembrolizumab; Pts: Patients; Ref: refractory; Rel: relapsed.

Figure 2

Cumulative incidence of engraftment. The 30-day cumulative incidence of neutrophil (A) and platelet (B) engraftment in the 1 salvage chemotherapy cohort (1 ST: black line) and in >1 rescue treatment (comprising brentuximab vedotin and checkpoint inhibitors) group (>1 ST: red line). ANC: absolute neutrophil count; ASCT: autologous stem cell transplantation; PLT: platelet; ST: salvage therapy.

Figure 3

Outcome of Hodgkin lymphoma patients with relapsed or refectory disease. The 2-year cumulative incidence of relapse (A) after ASCT in the 1 salvage line (1 ST: black line) vs. >1 rescue treatment cohorts (>1 ST: red line); Kaplan–Meier estimate of 3-year OS (B) and progression-free survival (C) in the 1 salvage line (1 ST: black line) vs. >1 rescue treatment cohorts (>1 ST: red line). ASCT: autologous stem cell transplantation; OS: overall survival; ST: salvage therapy.