Gunjan L. Shah1, Alison J. Moskowitz1, Sridevi Rajvee2, Susan J. McCall1, Molly A. Maloy1, Craig Sauter1, Sergio A. Giralt1, Matthew J. Matasar1, Craig H. Moskowitz1
1Memorial Sloan Kettering Cancer Center, New York, NY,2Mount Sinai St.Luke's-West Hospital, New York, NY
Background: In the AETHERA trial, brentuximab vedotin (BV) maintenance improved progression free survival (PFS) in BV naive Hodgkin Lymphoma (HL) patients (pt) at high risk for relapse (remission duration less than 1 year, extranodal disease or B-symptoms at relapse, requiring 2+ salvage regimens, or PET positive after salvage therapy) (Moskowitz Lancet 2015).
Methods: We retrospectively collected and descriptively analyzed the outcomes and toxicities of HL patients with BV prior to autologous hematopoietic stem cell transplant (AHCT) who received BV maintenance.
Results: From 2015–2016, 47 HL pts underwent AHCT with 27 receiving BV pre-AHCT and 8/27 (30%) receiving BV maintenance. Initial therapy was ABVD for 7/8 patients and BV-AVD in 1 pt with 50% having biopsy proven primary refractory disease and 38% having remission durations >1 year. At the time of relapse or refractory disease, 50% had stage III disease, 38% had B-symptoms, and no one had extranodal disease. First line salvage therapy was BV in 75%, with 2/6 needing 2nd salvage with augmented ICE. The remaining 2 pts received augmented ICE and GVD, with the latter receiving 2nd salvage BV. Pts received 3–8 doses of BV (1.2–1.8 mg/m2) prior to AHCT. At the time of AHCT, 75% were PET negative and 75% received BEAM conditioning. All patients were in complete remission at post-AHCT restaging with 5/8 (63%) having 2 or more AETHERA risk factors. BV maintenance started a median of 42 days post AHCT (range 37–45) and pts received a median of 10 doses (range 3–12) starting at 1.8 mg/m2. Patients were followed with CT imaging every 6 months. At a median follow-up of 29 months from AHCT, no patients have relapsed or died. A total of 16 doses (combining pre-and post AHCT BV) were planned with 4/8 (50%) completing the full course. Early discontinuation was due to neuropathy in 2 patients, fatigue and hair loss in 1 patient, and appearance of a ground glass infiltrate on CT in one patient. Four patients developed grade 1–2 neuropathy, while 1 patient who had neuropathy pre-AHCT did not have worsening symptoms. The neuropathy resolved in 3/5 patients once no longer receiving BV and the remaining patients having grade 1 symptoms persisting. Other symptoms including mild fatigue and arthralgias.
Conclusion: BV maintenance is safe and effective in BV exposed HL pts at high risk for relapse after AHCT. Close monitoring and early discontinuation should be considered if toxicities develop.