Skirmante Cernauskiene2, Ruta Semaskeviciene2, Orinta Mickeviciute2, Laimonas Griskevicius1,2
1 Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania, 2 Hematology, 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.