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.