Francesco Gaudio1, Patrizio Mazza2, Angelo Michele Carella3, Anna Mele4, Giulia Palazzo2, Giovanni Pisapia2, Paola Carluccio1, Domenico Pastore5, Nicola Cascavilla3, Giorgina Specchia1, Vincenzo Pavone4
1 Haematology, Policlinico Hospital, Bari, Italy, 2 Haematology, “G.Moscati” Hospital, Taranto, Italy, 3 Haematology, “Casa Sollievo della sofferenza” Hospital, San Giovanni Rotondo (FG), Italy, 4 Haematology, “G.Panico” Hospital, Tricase (LE), Italy, 5 Haematology, “A.Perrino” Hospital, Brindisi, Italy
Patients with classic Hodgkin's lymphoma (cHL) progressing after autologous stem cell transplantation (SCT) have a very poor outcome. Brentuximab vedotin (BV), an anti-CD30 targeting antibody-drug conjugate has been studied in this patients setting.
This study reports a retrospective multicenter experience of the Rete Ematologica Pugliese (REP) over the past 16 years, aiming to compare the patients characteristics and outcomes of 21 BV pre-treated patients to 51 patients who received reduced intensity conditioning (RIC) allogeneic SCT without prior BV, in the time period before the drug became available.
Methods: 72 patients with cHL who received allogeneic SCT from 2000 to 2017 were retrospectively studied. Median age was 34 years (range 16–57 years) and 36 (54%) were male. At the time of allogeneic SCT, 33 (46%) patients had chemosensitive disease and 39 (54%) were chemorefractory.
Results: Following transplantation, 40 patients relapsed or progressed at a median time of 6.3 months (range 1- 59 months) post-transplant.
After a median follow-up of 38 months (range 3–195 months) 41 patients remain alive and 26 have died. At univariate analysis, prior use of BV had no effect on either engraftment or the incidence and severity of acute graft versus host disease (GVHD). There was a lower incidence of chronic GVHD in the BV group, with a 41% cumulative incidence at 3 years versus 48% in the no BV group, but this was not statistically significant.
Despite the low incidence of chronic GVHD, we did not observe a worse survival in the BV treated group: 3-year progression free survival (PFS) was 64%, 3-year overall survival (OS) was 64%, 3-year non relapse mortality (NRM) was 19%. In the no-BV group the 3-year PFS was 32%, 3-year OS was 42%, 3-year NRM was 16%.
Conclusions: Allogeneic SCT may be an effective salvage strategy for patients who relapse after autologous SCT. Use of BV salvage treatment yields improved responses over conventional multi-agent chemotherapy with less toxicity, thereby providing better candidates for allogeneic SCT.