doi: 10.1097/01.HS9.0000547959.28876.b4
Relapsed/Refractory HL

C. Veldman1, M. Nijland1, T. van Meerten1, M. Hoogendoorn2, G. W. Huls1, W. J. Plattel1

1University of Groningen, University Medical Center Groningen, Department of Hematology, Groningen, Netherlands,2Medical Center Leeuwarden, Department of Hematology, The Netherlands

Background: Patients with refractory or relapsed classical Hodgkin lymphoma (R/R cHL) who are refractory to salvage chemotherapy generally have a poor prognosis. The aim of this study was to evaluate results of second line salvage chemotherapy with mini-BEAM (carmustine 60 mg/m2 day 1, etoposide 75 mg/m2 bid day 1–2, cytarabine 400 mg/m2 bid day 2, and melphalan 30 mg/m2 day 2) in case of refractory disease to DHAP based (dexamethasone 40 mg day 1–4, cytarabine 2000 mg/m2 bid day 2 and cisplatin 100 mg/m2 day 1) salvage chemotherapy.

Methods: Ninety-one patients with R/R cHL treated with DHAP based salvage chemotherapy between 1989 and 2017 at the University Medical Center Groningen were retrospectively identified. Response to DHAP and/or mini-BEAM was assessed with computer tomography and/or Positron Emission Tomography imaging. Patients with a complete response (CR) or partial response (PR) after DHAP chemotherapy proceeded to high dose chemotherapy and autologous stem cell transplant (ASCT). Patients with less than a PR were considered for mini-BEAM.

Results: Of the 91 patients with R/R cHL, a CR, PR and stable disease (SD) or progressive disease (PD) after DHAP chemotherapy was observed in 37 (41%), 26 (29%) and 28 (31%) patients, respectively. Sixty-four patients (70%) directly proceeded to ASCT. Twenty patients (22%) with a PR or SD received mini-BEAM as second salvage. Four patients (4%) did not receive transplant because of disease progression (1), failure to harvest stem cells (2) or patient's choice (1). Three patients died due to treatment toxicity (4%). Of the 20 patients who received mini-BEAM, 6 patients (30%) had CR and 4 patients (20%) had a PR. Fifteen patients (75%) proceeded to ASCT. The remaining 5 patients (25%) received palliative care because of PD. A CR after ASCT was observed in 10 of 15 patients (67%) treated with mini-BEAM as second salvage and was highly dependent on the response before ASCT. The 5-year progression-free survival and OS rate for patients receiving mini-BEAM followed by ASCT were 50% and 60%, respectively, compared to 75% and 77% for patients who directly proceeded to ASCT after DHAP chemotherapy.

Conclusion: Second salvage chemotherapy with mini-BEAM after failure to DHAP based first salvage therapy results in an overall response rate of 50% and favorable long-term survival after ASCT. Second salvage chemotherapy with mini-BEAM is a successful alternative in the era of more targeted and immunomodulating drugs.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.