D. Martineau1, M. Sauvezie1, L. Oberic2, A. Mazari3, A. Banos4, F. Bijou5, P. Brice6, A, Thyss7, AC Gac8, E. Gyan9, N. Milpied1, K. Bouabdallah1
1 Service d’hématologie Clinique, CHU Haut-Leveque, Pessac, France, 2 Service d’hématologie, Institut universitaire du Cancer de Toulouse-Oncopole, Toulouse, France, 3 Service d’hématologie Clinique, CHU Montpellier, Montpellier, France, 4 Service d’hématologie Clinique, Centre hospitalier de la côte Basque, Bayonne, France, 5 Service d’hématologie Clinique, Institut Bergonie, Bordeaux, France, 6 Service d’hématologie Clinique, Hôpital Saint-Louis, APHP, Paris, France, 7 Service d’hématologie Clinique, Centre Antoine Lacassagne, Nice, France, 8 Institut d’hématologie, centre hospitalier de Caen, Caen, France, 9 Service 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.