Skirmante Cernauskiene2, Ruta Semaskeviciene2, Orinta Mickeviciute2, Laimonas Griskevicius1,2
1Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania,2Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
Background: Relapsed or refractory (R/R) lymphoma patients (pts) who remain PET positive after platinum-based salvage chemotherapy and undergo autologous stem cell transplantation (ASCT) remain at high risk of relapse (about 60%, Smeltzer, et al. BBMT 2011). Here we present a retrospective single center analysis of PET-adapted sequential salvage therapy with BV followed by time-intensified GVD in pts who remain PET positive (Deauville (D) 4–5) after first line salvage therapy with DHAP.
Methods: We reviewed the medical records of all R/R CD30+ lymphoma pts remaining PET D 4–5 after first line DHAP salvage therapy over 2013 – 2017-year period. These pts received 2 or 4 cycles of biweekly BV (1.8 mg/kg) followed by 2 or 4 cycles of GVD (gemcitabine 1000 mg/m2, vinorelbine 20 mg/m2, pegylated liposomal doxorubicin 15 mg/m2 on days 1 and 14 every fourteen days). PET-CT scan was performed after 2 and 4 BV cycles and then after 2 and 4 GVD cycles. Pts reaching D 1–2 score at any time point proceeded directly to ASCT. Pts remaining D 3–5 continued with BV and GVD. Pts remaining D 3–5 after all BV and GVD cycles could have received ASCT according to physician's decision. Endpoints include progression-free and overall survival (PFS, OS, respectively) and grade 3–5 toxicity (CTCAE v. 4.03).
Results: 17 pts were enrolled, 16 had Hodgkin's and 1 had anaplastic large cell lymphoma. The median age at relapse was 37 years (range 21–70), the majority had advanced stage (64.7%). All pts were D 4–5 after DHAP. 8 and 2 pts became D 1–2 after BV and GVD, respectively, resulting in the overall D 1–2 response of 58.8%. ASCT was performed in 14 (82.4%) pts: 9 after BV and 5 after GVD. PET status at ASCT was D 1–2 in 10 pts (71.4%) and D 3–4 in 4 pts (28.6%). The median observation time was 53 months. 3 pts (17.6%) progressed during BV-GVD cycles, 2 pts (14.3%) pts relapsed after ASCT resulting in two (11.8%) lymphoma related deaths. 3-year PFS and OS were 76% and 88%, respectively (Figure 1.). BV was associated with grade 3–4 infections in two pts, whilst GVD was associated with grade 3–4 cardiotoxicity in two pts. No treatment related deaths occurred.
Conclusions: The sequential time-intensified BV - GVD resulted in high D 1–2 response (58.8%) amonge DHAP resistant CD30+ lymphoma patients with 82.4% proceeding to ASCT. 3-year PFS of 76% compares favorably with previous data (3-year EFS 41%, Smeltzer, et al. BBMT 2011) in patients autotransplanted in PET positive disease.