Christine Jansson1, Ingemar Lagerlöf2, Johan Linderoth3, Ann-Sofie Johansson4, Fredrik Ellin5, Marzia Palma6, Urban Jerlström7, Karin E. Smedby8, Daniel Molin9
1Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden,2Dept of Haematology, Linköping University Hospital, Linköping, Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden,3Department of Clinical Sciences, Division of Oncology and Pathology, Lund, Sweden,4Department of Radiation Sciences, Oncology, Norrlands University Hospital, Umeå, Sweden,5Department of Clinical Sciences, Lund, Lund University, Lund, Sweden,6Patient Area Hematology, Karolinska University Hospital, Stockholm, Sweden,7Dept of Oncology, Örebro University Hospital, Örebro, Sweden,8Division of clinical epidemiology, Dept of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,9Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
Background: About 20% of patients with Hodgkin lymphoma (HL) will relapse and only half of them are cured with autologous stem cell transplant (ASCT). Those with a second relapse have poor outcome and historically few treatment alternatives. The antibody-chemotherapy conjugate brentuximab vedotin (BV) has been used in Sweden since 2011.
Methods: This retrospective study aimed to evaluate the response to BV treatment in patients with relapsed/refractory HL in clinical routine. Thirtynine patients, median age 41 (range 17–78) treated with BV in Sweden during 2011–2017 were identified retrospectively from patient files. Not all centers in Sweden have been included in the analysis yet. Median number of previous therapies was two (range 1–9). Seventeen patients had received previous ASCT, three patients had received both ASCT and allo SCT and nineteen patients had no previous stem cell transplant (SCT). The primary endpoints were progression-free survival (PFS), overall survival (OS) and number proceeding to ASCT or allo SCT.
Results: The median number of cycles of BV was five (range 2–19). A majority (n = 24) of patients received BV with a curative intent, usually aiming for transplantation. The objective response rate was 56% (33% CR, 23% PR). 5-year OS and PFS from start of BV treatment were 62% and 33%. Fifteen patients received consolidation with SCT (10 allo, 5 auto), and 80% of them achieved a CR. The median duration of response for these patients was 25.1 months (range 1.7–70.9). Eleven of these patients were still in remission at latest follow-up. Patients (n = 24) who did not proceed to SCT had a median duration of response of 3.8 months (range 0.9–20.2), five still being in remission. The transplanted patients had 1-year PFS of 92% and 5-year PFS of 62%, compared to 1-year PFS of 24% in those not transplanted after BV (Figure 1).
Conclusion: Our study demonstrates that BV can be effective in heavily pre-treated patients with relapsed/refractory HL in real life, here with an objective response in 56%. Few allo SCT were performed in the pivotal trial that led to approval of BV (Younes 2012) and the long term results of those not transplanted seemed equal to those who have been transplanted (Chen 2016). However, in our cohort the outcome of those not transplanted was significantly poorer. Our data also support previous reports that BV can be used as a bridge to allo SCT, with lower treatment-related mortality compared to other strategies.