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
1 Memorial Sloan Kettering Cancer Center, New York, NY, 2 Mount 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.