D. Martineau1, M. Sauvezie1, L. Oberic2, A. Mazari3, A. Banos4, F. Bijou5, P. Brice6, A, Thyss7, AC Gac8, E. Gyan9, N. Milpied1, K. Bouabdallah1
1Service d’hématologie Clinique, CHU Haut-Leveque, Pessac, France,2Service d’hématologie, Institut universitaire du Cancer de Toulouse-Oncopole, Toulouse, France,3Service d’hématologie Clinique, CHU Montpellier, Montpellier, France,4Service d’hématologie Clinique, Centre hospitalier de la côte Basque, Bayonne, France,5Service d’hématologie Clinique, Institut Bergonie, Bordeaux, France,6Service d’hématologie Clinique, Hôpital Saint-Louis, APHP, Paris, France,7Service d’hématologie Clinique, Centre Antoine Lacassagne, Nice, France,8Institut d’hématologie, centre hospitalier de Caen, Caen, France,9Service d’hématologie Clinique, Centre hospitalier de Tours, Tours, France
Majority of patients with classical Hodgkin Lymphoma (HL) are cured with frontline therapy. However, between 20 to 30% of the patients will relapse. Achieving second complete remission (CR) after salvage therapy and prior to Autologous transplantation (ASCT) is a strong predictor marker of favorable outcome. One recent phase 1–2 study has shown that the combination of Brentuximab Vedotin and Bendamustine (BV+B) is an effective salvage regimen as a bridge to ASCT in patients with primary refractory or relapsed (R/R) HL. The main objective of this study was to evaluate the complete response (CR) rate after BV+B.
Eighty patients (pts) with R/R HL from 14 LYSA centres treated between 2014 and 2017 were retrospectively reviewed. BV was given at 1,8 mg/Kg on day 1 and Bendamustine at 90 mg/m2 on day 1 and 2 every 4 weeks. Patients were evaluated for response mainly after 3 cycles. Responders (CR or PR) and eligible patients underwent ASCT after BEAM conditioning regimen.
Median prior lines were 2 (1–11) and median number of BV+B cycles was 4 (1–7). 76 pts are evaluable for efficacy. The CR rates was 65%. After a median FU of 15,7 months, the estimated 2-year PFS and OS were 64% (23–29) and 88,5% (84,5–92,5) respectively. The median duration of response among the 45 pts in CR was not reached (71% (+/ − 6%) at 30 months.
After ASCT complete response rate was 81% (30/37) compared to 49% (17/35) in the group w/o ASCT (p = 0,01). Median PFS was not reached, compared to 20 months (17–23) for patients who didn’t received ASCT (p = 0,033) (Fig. 1). Median OS was not reached in both groups.
Twenty-two patients (41, 3%) experienced grade ≥ 2 toxicity. The main toxicities were hematological (43, 5%), infectious (34, 8%), cutaneous (13%), digestive (13%). Treatment was stopped for 7 patients due to toxicity. One patient died of septic shock and another one died of digestive hemorrhage during cycle 1.
BV+B is an effective salvage therapy in patients with R/R HL. Considering the very good outcome for patients in CR and after ASCT, its use as a bridge-to-transplantation therapy should be considered to achieve durable remission in eligible patients. Although manageable, toxicity should be carefully monitored.