doi: 10.1097/01.HS9.0000547968.07791.0f
Relapsed/Refractory HL

Antonio Russo1, Alessandro Pulsoni2, Francesca Ricci1, Rita Mazza1, Massimo Magagnoli1, Lucia Morello1, Marcello Rodari3, Alessandra Serrao2, Giorgia Annechini2, Andrea Nervini2, Laura Giordano1, Luca Castagna1, Arturo Chiti3,4, Armando Santoro1,4, Carmelo Carlo-Stella1,4

1Hematology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano-Milano, Italy,2Department of Cellular Biotechnology and Hematology, La Sapienza University, Rome, Italy,3Nuclear Medicine, Humanitas Research Hospital, Rozzano-Milano, Italy,4Department of Biomedical Sciences, Humanitas University, Rozzano-Milano, Italy

Introduction: In a multicenter phase II study, The BEGEV regimen has been proved an effective second-line therapy for relapsed/refractory classical Hodgkin Lymphoma (cHL) (Santoro et al., 2016). Here, we report a real-life analysis with BEGEV administered as second- or subsequent line therapy.

Patients and methods: From February 2013 to February 2018, 59 cHL patients (median age, 34 years; range, 19 – 70) received 4 courses of BEGEV as second (n = 38) or subsequent line (n = 21) therapy. Primary refractory patients were 55% in the second-line group and 76% in the group treated beyond second-line. The latter group received a median of 3 (range, 2–6) therapy lines prior to BEGEV; 11 of 21 patients (52%) had previously been treated with Gemcitabine (n = 9) and/or Bendamustine (n = 3) and 15 (71%) with Brentuximab Vedotin (BV). Nine patients (43%) had received autologous stem cell transplantation (auto-SCT).

Results: As reported in the phase 2 study, BEGEV had a good toxicity profile and all patients but 6 received the planned cycles. Reasons for premature therapy discontinuation included progressive disease (n = 5) and sepsis (n = 1). Overall, 39 patients achieved complete remission (CR) and 7 partial remission (PR) with an objective response rate (ORR) of 78%; stable disease and progressive disease (PD) were experienced by 1 and 11 (19%) patients, respectively. The ORR in patients receiving BEGEV beyond second-line was 76%. Interestingly, CR was achieved by all patients who were unresponsive to BV, all but one patient who had previously received auto-SCT, all but two patients pre-treated with Gemcitabine and all patients pre-treated with Bendamustine. All 46 patients that achieved a clinical response after BEGEV were offered SCT: 3 relapsed before SCT could be performed; 31 (67%) received auto-SCT and 8 (17%) allo-SCT; 3 patients are scheduled to perform the procedure, and 1 refused SCT. With a median follow-up of 392 days, the 1-yr overall survival (OS) and progression-free survival (PFS) are 91% and 72%, respectively. No significant OS or PFS difference was detected when comparing patients receiving BEGEV in second-line chemotherapy vs those receiving BEGEV beyond second line.

Conclusion: This real-life analysis shows that: (i) the BEGEV regimen is an effective treatment option for relapsed/refractory cHL treated beyond second-line and (ii) confirms BEGEV efficacy in patients with chemorefractory disease as well as in those failing auto-SCT and BV.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.