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P138 (0167) LONG-TERM HIGH DOSE CHEMO.THERAPY BEFORE HEMATOPOIETIC STEM CELL TRANSPLANTATION DUE TO RESTRICTED ACCESS TO NEW THERAPIES

doi: 10.1097/01.HS9.0000547981.14522.7d
Relapsed/Refractory HL

Tito Vanelli, Gueverson Rocha, Caroline Brum, Marcelo Capra, Elisa Schneider, Tahiane Soares, Gustavo Fischer, Luis Contin, Samira Fiorot Lodi, Geovana Botan, Laura Fogliato

Hospital Santa Rita, Irmandade Santa Casa de Misericórida, Porto Alegre, Rio Grande do Sul, Brazil

Relapsed or refractory Hodgkin lymphoma is a challenging problem. The standard management of these patients should include the use of salvage chemotherapy followed by autologous stem cell transplant (ASCT). In Brazil, the availability of the new drugs as brentuximab and nivolumab is restricted to the private health system, and consecutive cycles of salvage high dose chemotherapy treatment are the standard of care in most centers. Additionally, the restricted access to hematopoietic stem cell transplantation centers imposes to patient long-term high dose chemotherapy treatment. This abstract describes the characteristics of the patients and the treatment before the ASCT, from a single center in the South of Brazil. From 2006–2018, 60 patients with Hodgkin Lymphoma were transplanted in our center, 59 autologous and one allogenic. The median age was 27 years old (4 55), the majority were male (60%), the first line of treatment was ABVD in 98%, the first remission rate was 47% and the median time to progression or relapse was 12 months. The second line treatment was ICE in 43 (71%), GDP/GEMOX in 7 (12%), DHAP in 5 (8%) and five patients were treated with other therapies. The number of cycles, during second-line treatment, was 1–4 cycles in 50 (83%) and more than four cycles in 10 (27%) of the patients. Thirty-one patient went through the third line treatment. The protocols used were GDP/GEMOX in 17 (55%), Brentuximab in 7 (22%), DHAP in 4 (13%) and ICE in 3 (10%). The number of third-line cycles of treatment was 1–4 cycles in 21 (83%) and > 4, in 10 (27%). Nine patients (13%), from the total sample, were treated with the fourth line of therapy before HSC transplantation, and in this group only 4 (44%), brentuximab was used. The median time since the relapse/progression to HSC transplantation was twelve months (1–49). The median progression-free survival was 65 months (IC95% 133,8–184,5), and the mean overall survival was 159 months (median not reached). The stem cell collection failure rate was 25% in Hodgkin Lymphoma and associated with the increased number of treatment cycles (> 3 cycles, p = 0.02). In conclusion, high dose chemotherapy is the standard of care for relapsed/progression Hodgkin patients, however, the new drugs with less intensive hematologic toxicities are being used. The restricted access to these agents and to transplantation centers prolongs the high dose treatments and related adverse events.

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