Paul J. Bröckelmann1,2, Horst Müller1, Teresa Guhl1, Karolin Behringer1,2, Michael Fuchs1,2, Bastian von Tresckow1,2, Peter Borchmann1,2, Andreas Engert1,2
1German Hodgkin Study Group (GHSG), University Hospital of Cologne,2Department I of Internal Medicine, University Hospital of Cologne
Introduction: Contemporary therapy for classical Hodgkin lymphoma (HL) is tailored to disease extent and risk group with less intensive therapies evaluated in clinical trials to minimize late toxicities. The aim of this retrospective analysis was to evaluate disease and treatment characteristics at relapse after contemporary treatment for early-stage favorable HL. Particularly, a comparison of progression-free survival (PFS) after treatment with high-dose chemotherapy and autologous stem-cell transplantation (ASCT) or e.g. ABVD or BEACOPP polychemotherapy (CTx).
Methods: Patients with relapse after early-stage favorable HL treated within the GHSG trials HD10 and HD13 were identified in the GHSG database and detailed information was collected from patients’ files. Cases of primary refractory disease were excluded. The primary endpoint for comparison of CTx vs. ASCT was PFS after first relapse, whereby Cox proportional hazards regression was used to account for age and historical effects as confounders. Sensitivity analyses were performed with Kaplan-Meier statistics and overall survival (OS) after relapse.
Results: A total of 174 patients with relapse after treatment in HD10 (n = 53) and HD13 (n = 121) aged 21 to 81 years (median = 41 years) were identified. Relapse mostly occurred >12 months after first diagnosis (142 patients = 82%), stage I/II disease was present in 99/164 patients (60%) with documented disease extent. 85 of 172 patients with identified therapy were treated with CTx (49%), 70 with ASCT (41%), 11 with radiotherapy (6%) and 4 with a palliative regimen (2%). Of patients treated with CTx, 68% received BEACOPP, 19% received ABVD and 13% other CTx. Patients aged >60 years at relapse were mostly treated with CTx (33/49 = 67%) and rarely with ASCT (8 = 16%). Adjusted for age and the observed historical disadvantage of ASCT in the HD10 trial, there was no relevant difference in efficacy of CTx and ASCT (hazard ratio (HR) = 0.7, p = 0.39, Table 1). In HD13 patients aged ≤60 years, 2-year PFS after relapse was 92.6% with CTx (95%-confidence-interval (CI) = 84.5%–100%) vs. 89.1% with ASCT (CI = 80.0%–98.2%). Findings for the secondary endpoint OS were equivalent.
Summary: After contemporary treatment for early-stage favorable HL, relapse mostly occurs >12 months after first diagnosis. Polychemotherapeutic regimens such as BEACOPP or ABVD are frequently administered and may constitute a reasonable treatment alternative to ASCT in this setting.