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Goto A, Fujita C, Horiguchi H, Iyama S, Kobune M. Successful Pregnancy and Fetal Outcomes Following Brentuximab Vedotin for Early Relapsed Classic Hodgkin Lymphoma After Autologous Stem Cell Transplant. Cureus 2024; 16:e57291. [PMID: 38690456 PMCID: PMC11058904 DOI: 10.7759/cureus.57291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Brentuximab vedotin (BV), an anti-CD30 antibody with monomethyl auristatin E conjugate, has shown clinical effects against relapsed/refractory classic Hodgkin lymphoma (cHL) and hence is widely used in the clinical setting. We report a special clinical case of successful pregnancy and fetal outcome in a patient with cHL who achieved long-term remission with BV for early relapse after an autologous stem cell transplant (auto-SCT). A 27-year-old woman with advanced cHL achieved complete response (CR) after six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen. Embryos obtained from intracytoplasmic sperm injection were cryopreserved before the initiation of induction chemotherapy. Despite achieving a second CR following intensive salvage chemotherapy, auto-SCT, and radiotherapy, she relapsed again six months after transplantation. BV monotherapy was administered as salvage therapy. She completed 16 cycles of BV and achieved CR. Six months after BV completion, she expressed her desire to bear a child. She achieved pregnancy through third in vitro fertilization and embryo transfer and delivered a healthy baby. BV may provide a potentially curative treatment for patients with cHL relapsed after auto-SCT. Pregnancy should be avoided during BV administration up to a certain period after the end of administration. Fertility preservation is important for adolescent and young adult cancer survivors, and patients should be informed of cancer-related infertility and fertility preservation options prior to the initiation of cancer treatment.
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Affiliation(s)
- Akari Goto
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Chisa Fujita
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Hiroto Horiguchi
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Satoshi Iyama
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Masayoshi Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
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Randall MP, Spinner MA. Optimizing Treatment for Relapsed/Refractory Classic Hodgkin Lymphoma in the Era of Immunotherapy. Cancers (Basel) 2023; 15:4509. [PMID: 37760478 PMCID: PMC10526852 DOI: 10.3390/cancers15184509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Most patients with classic Hodgkin lymphoma (cHL) are cured with combination chemotherapy, but approximately 10-20% will relapse, and another 5-10% will have primary refractory disease. The treatment landscape of relapsed/refractory (R/R) cHL has evolved significantly over the past decade following the approval of brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate, and the PD-1 inhibitors nivolumab and pembrolizumab. These agents have significantly expanded options for salvage therapy prior to autologous hematopoietic cell transplantation (AHCT), post-transplant maintenance, and treatment of relapse after AHCT, which have led to improved survival in the modern era. In this review, we highlight our approach to the management of R/R cHL in 2023 with a focus on choosing first salvage therapy, post-transplant maintenance, and treatment of relapse after AHCT. We also discuss the management of older adults and transplant-ineligible patients, who require a separate approach. Finally, we review novel immunotherapy approaches in clinical trials, including combinations of PD-1 inhibitors with other immune-activating agents as well as novel antibody-drug conjugates, bispecific antibodies, and cellular immunotherapies. Ongoing studies assessing biomarkers of response to immunotherapy and dynamic biomarkers such as circulating tumor DNA may further inform treatment decisions and enable a more personalized approach in the future.
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Affiliation(s)
| | - Michael A. Spinner
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
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Osmani AH, Khafaga Y, Rauf MS, Maghfoor I, Akhtar S. Impact of Radiation Therapy After High Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation in Patients With Relapsed/Refractory Lymphomas: A Single Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e149-e160. [PMID: 34627735 DOI: 10.1016/j.clml.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION After high dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT), in patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), involved field radiation therapy (RT) for consolidation and residual/progressive disease (PD) eradication is a common practice. MATERIALS AND METHODS Retrospective single-institution cohort analysis to evaluate the impact of early RT after HDC auto-SCT. RESULTS Between 1996 and October 2019, 153 patients (43 DLBCL, 110 HL) underwent RT after HDC auto-SCT. Males 95 (62%), females 58 (38%), median age 24 years. Indications for RT was consolidation 65%: residual disease eradication 16%: and PD eradication 19%. For DLBCL, the median overall survival (OS) for the above indications was not reached (NR):NR:2 months and the KM 5-year OS was 72.6%:64.3%:12.5% respectively (P ≤ .000). Pair-wise analysis showed that consolidation versus residual disease eradication had no difference (P = .88) but both were superior to PD disease eradication (P ≤ 000 and P = .005 respectively). For HL, indication for RT was, 54%:23%:24% respectively. The median OS was NR:NR:28.8 months and KM 5-year OS was 82.3%:78%:30% respectively (P ≤ .000). Pair-wise analysis showed that consolidation versus residual disease eradication had no difference (P = .98) but both were superior to the PD eradication group (P ≤ 000). RT was well tolerated with no significant long-term toxicity. CONCLUSION Post HDC auto-SCT RT was well tolerated. DLBCL and HL patients with residual disease treated with the RT had similar long-term survival as those who received RT for consolidation. RT failed to improve the poor survival in patients with post-HDC auto-SCT PD.
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Affiliation(s)
- Asif Husain Osmani
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Khafaga
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad Shahzad Rauf
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Kingdom of Saudi Arabia
| | - Irfan Maghfoor
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Kingdom of Saudi Arabia
| | - Saad Akhtar
- King Faisal Specialist Hospital and Research Center, Oncology Center, Riyadh, Kingdom of Saudi Arabia.
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Kaloyannidis P, Omari R, Eldebawy E, Al Shaibani E, Apostolidis J, Hindi T, Raslan H, Al Garni A, Al Buali A, Al Anezi K, Al Hashmi H. Favorable Outcome After Adjuvant Involved-Field Radiotherapy After Autologous Hematopoietic Stem-Cell Transplantation in Patients With High-Risk Relapsed/Refractory Lymphoma: A Single-Center Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e112-e119. [PMID: 33060051 DOI: 10.1016/j.clml.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with refractory or relapsed lymphoma diagnosed with bulky disease at relapse or with residual disease after salvage treatment are considered to have a dismal outcome, even after autologous hematopoietic stem-cell transplantation, as a result of disease recurrence. To minimize the risk of relapse after receipt of a transplant, involved-field radiotherapy (IFRT) to sites of either bulky or localized residual disease has been utilized; however, the ideal timing for irradiation remains controversial. The aim of this study was to assess the safety and efficacy of IFRT in the early period after transplantation. PATIENTS AND METHODS We retrospectively evaluated the outcome of 24 autografted patients with relapsed/refractory lymphoma who presented with bulky disease at relapse or who had a persistent localized residual mass after salvage treatment and consolidated with IFRT within 4 months after autografting. RESULTS No significant toxicity was noticed during the early postradiotherapy period, while graft function was not impaired. After a median follow-up of 3 years for survivors, 21 patients were alive, 19 of whom were event free, while 2 patients died of disease recurrence and 1 died of treatment-related myelodysplastic syndrome. The 3-year overall, lymphoma relapse-free, and event-free survival rates were 86%, 86%, and 82%, respectively. CONCLUSION Taking into consideration the poor-risk features of the study cohort, IFRT provided early after autologous hematopoietic stem-cell transplantation showed a safe and well-tolerated toxicity profile and demonstrated long-term effective tumor control, as reflected in the promising survival rates.
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Affiliation(s)
- Panayotis Kaloyannidis
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
| | - Rawan Omari
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Eman Eldebawy
- Radiation Oncology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Eshrak Al Shaibani
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - John Apostolidis
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Taghreed Hindi
- Radiation Oncology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Heba Raslan
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ayed Al Garni
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahmed Al Buali
- Department of Medical Imaging, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Khalid Al Anezi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hani Al Hashmi
- Adult Hematology and Stem Cell Transplantation Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Vassilakopoulos TP, Asimakopoulos JV, Konstantopoulos K, Angelopoulou MK. Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies. Ther Adv Hematol 2020; 11:2040620720902911. [PMID: 32110285 PMCID: PMC7026824 DOI: 10.1177/2040620720902911] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (rr-cHL) has improved considerably in recent years owing to the approval of highly active novel agents such as brentuximab vedotin and Programmed Death-1 (PD-1) inhibitors. Although no randomized trials have been conducted to provide formal proof, it is almost undisputable that the survival of these patients has been prolonged. As autologous stem-cell transplantation (SCT) remains the standard of care for second-line therapy of most patients with rr-cHL, optimization of second-line regimens with the use of brentuximab vedotin, or, in the future, checkpoint inhibitors, is promising to increase both the eligibility rate for transplant and the final outcome. The need for subsequent therapy, and especially allogeneic SCT, can be reduced with brentuximab vedotin consolidation for 1 year, while pembrolizumab is also being tested in this setting. Several other drug categories appear to be active in rr-cHL, but their development has been delayed by the appearance of brentuximab vedotin, nivolumab and pembrolizumab, which have dominated the field of rr-cHL treatment in the last 5 years. Combinations of active drugs in chemo-free approaches may further increase efficacy and hopefully reduce toxicity in rr-cHL, but are still under development.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 17 Ag. Thoma Str., Goudi, Athens, 11527, Greece
| | - John V. Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maria K. Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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6
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Kaloyannidis P, Hertzberg M, Webb K, Zomas A, Schrover R, Hurst M, Jacob I, Nikoglou T, Connors JM. Brentuximab vedotin for the treatment of patients with relapsed or refractory Hodgkin lymphoma after autologous stem cell transplantation. Br J Haematol 2019; 188:540-549. [PMID: 31588564 PMCID: PMC7028067 DOI: 10.1111/bjh.16201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022]
Abstract
Brentuximab vedotin (BV) is the first approved novel agent for salvage treatment of relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL) after autologous stem cell transplantation (ASCT). In this study, a literature-based analysis was undertaken to assess, via an indirect treatment comparison, the comparative efficacy of BV to salvage chemotherapy as treatment for R/R cHL patients following ASCT. This comparative effectiveness research was undertaken to support a reimbursement submission for BV to the Australian Pharmaceutical Benefits Advisory Committee. Retrospective analysis of individual patient data from four data sources demonstrated that the use of BV as first salvage treatment in cHL patients relapsing or progressing post-ASCT achieved improvements in both clinical response and overall survival. More specifically, BV was associated with an incremental improvement of 22% in overall response rate compared to salvage chemotherapy. Five-year overall survival and progression-free survival rates were 92·2% [95% confidence interval (CI): 85·5-99·3%] and 32·2% (95% CI: 19·1-54·6%) respectively for BV, compared to 30·5% (95% CI: 22·2-42·0%) and 3·2% (95% CI: 1·1-8·9%) respectively for salvage chemotherapy. The encouraging results from this conservative analysis have the potential to support informed clinical management and funding decisions for the first salvage of cHL patients demonstrating recurrence after ASCT.
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Affiliation(s)
| | - Mark Hertzberg
- Prince of Wales Hospital, and University of NSW, Randwick, NSW, Australia
| | - Kate Webb
- Takeda Pharmaceuticals, Sydney, NSW, Australia
| | - Athanasios Zomas
- Takeda Europe & Canada Business Unit (EUCAN), Zurich, Switzerland
| | | | - Michael Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Ian Jacob
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Thalia Nikoglou
- Takeda Europe & Canada Business Unit (EUCAN), Zurich, Switzerland
| | - Joseph M Connors
- BC Cancer Centre for Lymphoid Cancer and the University of British Columbia, Vancouver, BC, Canada
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7
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019; 11:E1071. [PMID: 31362369 PMCID: PMC6721364 DOI: 10.3390/cancers11081071] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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8
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Vassilakopoulos TP, Chatzidimitriou C, Asimakopoulos JV, Arapaki M, Tzoras E, Angelopoulou MK, Konstantopoulos K. Immunotherapy in Hodgkin Lymphoma: Present Status and Future Strategies. Cancers (Basel) 2019. [PMID: 31362369 DOI: 10.3390/cancers] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although classical Hodgkin lymphoma (cHL) is usually curable, 20-30% of the patients experience treatment failure and most of them are typically treated with salvage chemotherapy and autologous stem cell transplantation (autoSCT). However, 45-55% of that subset further relapse or progress despite intensive treatment. At the advanced stage of the disease course, recently developed immunotherapeutic approaches have provided very promising results with prolonged remissions or disease stabilization in many patients. Brentuximab vedotin (BV) has been approved for patients with relapsed/refractory cHL (rr-cHL) who have failed autoSCT, as a consolidation after autoSCT in high-risk patients, as well as for patients who are ineligible for autoSCT or multiagent chemotherapy who have failed ≥ two treatment lines. However, except of the consolidation setting, 90-95% of the patients will progress and require further treatment. In this clinical setting, immune checkpoint inhibitors (CPIs) have produced impressive results. Both nivolumab and pembrolizumab have been approved for rr-cHL after autoSCT and BV failure, while pembrolizumab has also been licensed for transplant ineligible patients after BV failure. Other CPIs, sintilimab and tislelizumab, have been successfully tested in China, albeit in less heavily pretreated populations. Recent data suggest that the efficacy of CPIs may be augmented by hypomethylating agents, such as decitabine. As a result of their success in heavily pretreated disease, BV and CPIs are moving to earlier lines of treatment. BV was recently licensed by the FDA for the first-line treatment of stage III/IV Hodgkin lymphoma (HL) in combination with AVD (only stage IV according to the European Medicines Agency (EMA)). CPIs are currently being evaluated in combination with AVD in phase II trials of first-line treatment. The impact of BV and CPIs was also investigated in the setting of second-line salvage therapy. Finally, combinations of targeted therapies are under evaluation. Based on these exciting results, it appears reasonable to predict that an improvement in survival and a potential increase in the cure rates of cHL will soon become evident.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
| | - Chrysovalantou Chatzidimitriou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - John V Asimakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Evangelos Tzoras
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma. J Clin Oncol 2018; 36:JCO1800122. [PMID: 30285558 PMCID: PMC6241679 DOI: 10.1200/jco.18.00122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. PATIENTS AND METHODS We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. RESULTS AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. CONCLUSION Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.
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Affiliation(s)
- Scott F. Huntington
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Gottfried von Keudell
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Amy J. Davidoff
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Cary P. Gross
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sapna A. Prasad
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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10
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Tsirigotis P, Vassilakopoulos T, Batsis I, Bousiou Z, Gkirkas K, Sakellari I, Kaloyannidis P, Roussou P, Pangalis GA, Moschogiannis M, Vassilopoulos G, Repousis P, Megalakaki A, Michalis E, Kalpadakis C, Papadaki HA, Kotsianidis I, Hatzimichael E, Spyridonidis A, Anargyrou K, Poulakidas E, Giannoullia P, Apostolidis I, Stamouli M, Konstantopoulos K, Pappa V, Panayiotidis P, Harhalakis N, Anagnostopoulos A, Angelopoulou M. Positive impact of brentuximab vedotin on overall survival of patients with classical Hodgkin lymphoma who relapse or progress after autologous stem cell transplantation: A nationwide analysis. Hematol Oncol 2018; 36:645-650. [PMID: 29882363 DOI: 10.1002/hon.2521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 11/12/2022]
Abstract
The outcome of patients with relapsed/refractory classical Hodgkin lymphoma (R/R cHL) after autologous stem cell transplantation (auto-SCT) is poor. Recently, the anti-CD30 monoclonal antibody-drug conjugate, brentuximab vedotin (BV), has shown remarkable activity in the setting of R/R cHL. In the pivotal phase II study, BV produced an overall response rate of 75% and a median progression-free survival of 6.7 months. Although these results have been reproduced by large registry studies, the impact of BV on the overall survival (OS) of patients with R/R cHL has not been addressed so far. The aim of this study was to examine the impact of BV on OS in the setting of post auto-SCT R/R cHL. Analysis was performed in a group of patients with R/R cHL after a previous auto-SCT reported in the Greek registry during the last 2 decades. By using a multivariate model and censoring patients at the time of subsequent allo-SCT or treatment with immune checkpoint inhibitors, we showed that treatment with BV in the posttransplant relapse setting has a positive impact on the outcome and results in significant improvement of OS. To our knowledge, this the first published study, addressing the impact of BV on the OS in the setting of posttransplant relapse.
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Affiliation(s)
- Panagiotis Tsirigotis
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | | | - Ioannis Batsis
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | - Zoi Bousiou
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | - Konstantinos Gkirkas
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | - Ioanna Sakellari
- Dept of Hematology and BMT, PAPANIKOLAOU Hospital, Thessaloniki, Greece
| | | | | | | | | | | | | | | | | | | | - Helen A Papadaki
- Dept of Hematology, University Hospital of Crete, Heraklion, Greece
| | | | | | | | | | - Elias Poulakidas
- Dept of Hematology, 401 Military Hospital of Athens, Athens, Greece
| | | | | | - Maria Stamouli
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
| | | | - Vassiliki Pappa
- Second Dept of Internal Medicine Propaedeutic, ATTIKO General University Hospital, Athens, Greece
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11
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Survival analysis of patients with Hodgkin lymphoma who failed high dose chemotherapy and autologous stem cell transplant. Ann Hematol 2018; 97:1229-1240. [PMID: 29484455 DOI: 10.1007/s00277-018-3283-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
Hodgkin lymphoma (HL) patients failing after high dose chemotherapy (HDC) and auto-SCT have a poor outcome. Some patients may still benefit from further treatments. From 1996 to 2016, 137 HL patients (39.5%) out of 347 transplanted experienced post auto-SCT failure. Males/female 61%:39%, median age at auto-SCT 23.4 years and median follow-up 55.6 months (9-153). Type of failure was progressive (46%), relapsed (35%) or persistent disease/refractory disease (19%). Median overall survival (OS) from the time of failure is 20 months; 35 patients (25.5%) are alive. One hundred and four patients received treatment; the response rate was 45%; complete remission in 41 (30%) and partial remission in 21 (15%) patients. 1st interventions post auto-SCT were chemotherapy (39%), radiation therapy (35%) or best supportive care (24%). Twenty-seven patients with 2nd-SCT (allogeneic (15), auto-SCT (2)) and/or brentuximab (18 patients) had superior OS (50.6 months) vs other treatments (22.5 months, P value 0.037). COX regression multivariate analysis identified post auto-SCT treatment failure before 12 months (hazard ratio (HR) 3.37, CI 1.7-6.6, P value < 0.001), presence of B symptoms (HR 2.55, CI 1.4-4.6, P value 0.002), stages III-IV (HR 2.7, CI 1.5-4.9, P value 0.001), albumin < 4 g/dl (HR 1.76, CI 1.1-2.9, P value 0.027) and tumor > 5 cm (HR 1.1.9, CI 1.13-3.25, P value 0.015) as significant risk factors; P value < 0.001. KM OS with 0-1 factor (148.6 months): 2 factors (23.6 months) and 3-5 factors (9.4 months) (P value < 0.001). OS was 63%:25%:7% respectively with 0-1:2:3-5 factors respectively (P value < 0.001). Despite high-risk factors, 2nd-SCT/brentuximab use post HDC auto-SCT failure may result in durable survival.
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12
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Angelopoulou MK, Vassilakopoulos TP, Batsis I, Sakellari I, Gkirkas K, Pappa V, Giannoulia P, Apostolidis I, Apostolopoulos C, Roussou P, Panayiotidis P, Dimou M, Kyrtsonis M, Palassopoulou M, Vassilopoulos G, Moschogiannis M, Kalpadakis C, Margaritis D, Spyridonidis A, Michalis E, Anargyrou K, Repousis P, Hatzimichael E, Bousiou Z, Poulakidas E, Grentzelias D, Harhalakis N, Pangalis GA, Anagnostopoulos A, Tsirigotis P. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma. The Hellenic experience. Hematol Oncol 2018; 36:174-181. [PMID: 28219112 PMCID: PMC5836920 DOI: 10.1002/hon.2383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 01/24/2023]
Abstract
This retrospective study aimed to describe the Hellenic experience on the use of brentuximab vedotin (BV) in relapsed/refractory (R/R) Hodgkin lymphoma (HL) given within its indication. From June 2011 to April 2015, ninety-five patients with R/R HL, who received BV in 20 centers from Greece, were analyzed. Their median age was 33 years, and 62% were males. Sixty-seven patients received BV after autologous stem cell transplantation failure, whereas 28 patients were treated with BV without a prior autologous stem cell transplantation, due to advanced age/comorbidities or chemorefractory disease. The median number of prior treatments was 4 and 44% of the patients were refractory to their most recent therapy. The median number of BV cycles was 8 (range, 2-16), and the median time to best response was the fourth cycle. Fifty-seven patients achieved an objective response: twenty-two (23%), a complete response (CR), and 35 patients (37%), a partial, for an overall response rate of 60%. Twelve patients (13%) had stable disease, and the remaining twenty-six (27%) had progressive disease as their best response. At a median follow-up of 11.5 months, median progression-free survival and overall survival were 8 and 26.5 months, respectively. Multivariate analysis showed that chemosensitivity to treatment administered before BV was associated with a significantly increased probability of achieving response to BV (P = .005). Bulky disease (P = .01) and response to BV (P <.001) were significant for progression-free survival, while refractoriness to most recent treatment (P = .04), bulky disease (P = .005), and B-symptoms (P = .001) were unfavorable factors for overall survival. Among the 22 CRs, 5 remain in CR with no further treatment after BV at a median follow-up of 13 months. In conclusion, our data indicate that BV is an effective treatment for R/R HL patients even outside clinical trials. Whether BV can cure a fraction of patients remains to be seen.
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Affiliation(s)
- Maria K. Angelopoulou
- Department of Hematology, Laikon General HospitalNational and Kapodistrian University of AthensAthensGreece
| | | | - Ioannis Batsis
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Ioanna Sakellari
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Konstantinos Gkirkas
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Vasiliki Pappa
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | | | | | - Christos Apostolopoulos
- Third Department of Medicine, “Sotiria” General Hospital of Thoracic Diseases, Hematology UnitNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Paraskevi Roussou
- Third Department of Medicine, “Sotiria” General Hospital of Thoracic Diseases, Hematology UnitNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Panayiotis Panayiotidis
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Maria Dimou
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Marie‐Christine Kyrtsonis
- 1st Department of Propedeutic Internal Medicine, Laikon General HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
| | - Maria Palassopoulou
- Department of Hematology, Larissa University HospitalUniversity of ThessaliaLarissaGreece
| | - Georgios Vassilopoulos
- Department of Hematology, Larissa University HospitalUniversity of ThessaliaLarissaGreece
| | | | - Christina Kalpadakis
- Department of Hematology, Heraklion University HospitalUniversity of CreteHeraklionGreece
| | - Dimitrios Margaritis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | | | - Eurydiki Michalis
- Department of Clinical Hematology“G.Gennimatas” Athens General HospitalAthensGreece
| | | | | | | | - Zoi Bousiou
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Elias Poulakidas
- Department of Hematology401 Military Hospital of AthensAthensGreece
| | | | | | - Gerassimos A. Pangalis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | - Achilles Anagnostopoulos
- Hematology and Bone Marrow Transplantation DepartmentGeneral Hospital of Thessaloniki PapanikolaouThessalonikiGreece
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Faculty of Medicine, ATTIKON General University HospitalNational and Kapodistrian University of Athens, Medical SchoolAthensGreece
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13
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High dose chemotherapy and autologous stem cell transplantation in relapsed or refractory Hodgkin lymphoma: Emerging questions, newer agents, and changing paradigm. Hematol Oncol Stem Cell Ther 2017. [DOI: 10.1016/j.hemonc.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Pellegrini C, Broccoli A, Pulsoni A, Rigacci L, Patti C, Gini G, Mannina D, Tani M, Rusconi C, Romano A, Vanazzi A, Botto B, Santoro A, Hoaus S, Rigolin GM, Musto P, Mazza P, Molica S, Corradini P, Fama A, Gaudio F, Merli M, Ronconi F, Gritti G, Vallisa D, Tosi P, Liberati AM, Pinto A, Pavone V, Gherlinzoni F, Bianchi MP, Volpetti S, Trentin L, Goldaniga MC, Bonfichi M, De Renzo A, Schiavotto C, Spina M, Carella AM, Stefoni V, Argnani L, Zinzani PL. Italian real life experience with brentuximab vedotin: results of a large observational study on 234 relapsed/refractory Hodgkin's lymphoma. Oncotarget 2017; 8:91703-91710. [PMID: 29207679 PMCID: PMC5710959 DOI: 10.18632/oncotarget.18114] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022] Open
Abstract
A large Italian multicenter observational retrospective study was conducted on the use of brentuximab vedotin (BV) for patients with relapsed Hodgkin's lymphoma (HL) to check if clinical trial results are confirmed even in a real life context. 234 CD30+ HL patients were enrolled. Best response was observed after a median of 4 cycles in 140 patients (59.8%): 74 (31.6%) patients obtained a complete response (CR) and 66 (28.2%) achieved a partial response (PR); overall response rate at the end of the treatment was 48.3% (62 CR and 51 PR). The best response rate was higher in the elderly subset: 14 (50%) CR and 5 (17.8%) PR. Disease free survival was 26.3% at 3 years and progression free survival 31.9% at 4.5 years. Duration of response did not differ for who achieved at least PR and then either did or did not undergo consolidative transplant. Overall, the treatment was well tolerated and no death has been linked to BV-induced toxicity. Our report confirms activity in elderly patients, duration of response unrelated to the consolidation with transplant procedure, the relevance of the CR status at first restaging, and the role of BV as a bridge to transplant for chemorefractory patients.
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Affiliation(s)
- Cinzia Pellegrini
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Alessandro Broccoli
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Alessandro Pulsoni
- Department of Cellular Biotechnologies and Hematology, Hematology, Sapienza University, Rome, Italy
| | - Luigi Rigacci
- Department of Hematology, University and Hospital Careggi, Firenze, Italy
| | - Caterina Patti
- Department of Hematology, Azienda Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Guido Gini
- Department of Hematology, Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | | | | | - Barbara Botto
- Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Armando Santoro
- Oncology and Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - Stefan Hoaus
- Institute of Hematology, Catholic University, Rome, Italy
| | | | - Pellegrino Musto
- Scientific Direction, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Pz, Italy
| | - Patrizio Mazza
- Ospedale Moscati, Department of Hematology-Oncology, Taranto, Italy
| | - Stefano Molica
- Department of Hematology, Ciaccio-Pugliese Hospital, Catanzaro, Italy
| | - Paolo Corradini
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Angelo Fama
- Hematology Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | | | - Michele Merli
- Hematology, Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Fioravante Ronconi
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Napoli, Italy
| | - Giuseppe Gritti
- Department of Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Daniele Vallisa
- Division of Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Patrizia Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | | | - Antonello Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione Pascale, IRCCS, Napoli, Italy
| | - Vincenzo Pavone
- Division of Hematology, Ospedale G. Panico, Tricase, Lecce, Italy
| | | | | | - Stefano Volpetti
- Department of Hematology, DISM, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Maria Cecilia Goldaniga
- Onco-Hematology Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | - Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | | | - Vittorio Stefoni
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
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15
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Bair SM, Strelec L, Nagle SJ, Nasta SD, Landsburg DJ, Mato AR, Loren AW, Schuster SJ, Stadtmauer EA, Svoboda J. Outcomes of patients with relapsed/refractory Hodgkin lymphoma progressing after autologous stem cell transplant in the current era of novel therapeutics: A retrospective analysis. Am J Hematol 2017; 92:879-884. [PMID: 28512788 DOI: 10.1002/ajh.24792] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 12/20/2022]
Abstract
Patients with relapsed/refractory Hodgkin lymphoma (RR-HL) who progress or relapse following autologous stem cell transplantation (ASCT) have historically had a poor prognosis. Several novel agents, particularly brentuximab vedotin, have shown efficacy in this setting. However, there remains a paucity of data characterizing outcomes outside of clinical trials and how these novel agents have impacted prognosis in general population of patients with RR-HL. Here, we conducted a retrospective analysis to evaluate outcomes in 87 patients with RR-HL with relapse post-ASCT. Treatment with novel agents (including brentuximab vedotin) was associated with significant improvement in median overall survival (OS) compared to patients who did not receive novel agents (85.6 vs 17.1 months; P < .001). Additional factors associated with improved OS in univariate analysis include treatment with radiation therapy post-ASCT (34.1 vs 17.0 months; P = .015), chemosensitivity (i.e., relapsed compared to primary refractory disease; 51.8 vs 25.6 months; p = 0.013), initial response to ASCT (i.e., CR/PR compared to SD/PD; 46.1 vs 20.4 months; P = .011), and transplantation in 2010 and later compared to prior to 2010 (not reached vs 24.5 months; P = .025). The current study demonstrates markedly improved OS in RR-HL patients treated with novel therapeutics and lends "real world" credence to the role of these agents in improving outcomes in the current era.
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Affiliation(s)
- Steven M. Bair
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Lauren Strelec
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Sarah J. Nagle
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Sunita D. Nasta
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Daniel J. Landsburg
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Anthony R. Mato
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Alison W. Loren
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Stephen J. Schuster
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Edward A. Stadtmauer
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
| | - Jakub Svoboda
- Hospital of the University of Pennsylvania, Department of Medicine; Division of Hematology/Oncology, Perelman Center for Advanced Medicine; Philadelphia Pennsylvania 19104
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16
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Hui L, von Keudell G, Wang R, Zeidan AM, Gore SD, Ma X, Davidoff AJ, Huntington SF. Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer 2017. [PMID: 28640385 DOI: 10.1002/cncr.30818] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent randomized, placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs remain unclear. METHODS A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after ASCT. Life-time costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. RESULTS After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses. CONCLUSIONS BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values. Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:3763-3771. © 2017 American Cancer Society.
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Affiliation(s)
- Lucy Hui
- Yale School of Medicine, New Haven, Connecticut
| | - Gottfried von Keudell
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Amer M Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Steven D Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Amy J Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
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17
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Treatment pathways and resource use associated with recurrent Hodgkin lymphoma after autologous stem cell transplantation. Bone Marrow Transplant 2017; 52:452-454. [PMID: 28092356 PMCID: PMC5339415 DOI: 10.1038/bmt.2016.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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18
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Tsirigotis P, Danylesko I, Gkirkas K, Shem-Tov N, Yerushalmi R, Stamouli M, Avigdor A, Spyridonidis A, Gauthier J, Goldstein G, Apostolidis J, Mohty M, Shimoni A, Nagler A. Brentuximab vedotin in combination with or without donor lymphocyte infusion for patients with Hodgkin lymphoma after allogeneic stem cell transplantation. Bone Marrow Transplant 2016; 51:1313-1317. [DOI: 10.1038/bmt.2016.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 11/09/2022]
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19
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Bonthapally V, Wu E, Macalalad A, Yang H, Shonukan O, Liu Y, Chi A, Huebner D. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma post-autologous transplant: meta-analysis versus historical data. Curr Med Res Opin 2015; 31:993-1001. [PMID: 25772232 DOI: 10.1185/03007995.2015.1030378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This meta-analysis evaluated the antitumor activity of brentuximab vedotin versus historical values in patients with relapsed/refractory Hodgkin lymphoma post-autologous stem cell transplantation (ASCT). METHODS A systematic literature review identified studies (1993-February 2013) reporting complete remission (CR) rates in patients with relapsed/refractory Hodgkin lymphoma post-ASCT. Publications reporting CR rates, identified through interrogation of multiple electronic databases and manual searches (with search terms used to capture 'relapsed', 'refractory', 'HL', and 'ASCT'), were included if they reported: ≥20 relapsed/refractory Hodgkin lymphoma patients, where ≥80% were aged ≥12 years and ≥50% had failed prior ASCT. Overall CR rate was determined using a random-effect model, and compared with that reported for brentuximab vedotin in a pivotal phase 2 trial (SG035-0003). MAIN OUTCOME MEASURES Across 17 evaluable studies of historical or experimental agents (n = 812), the estimated overall CR rate was 11.1% (95% confidence interval [CI] 7.0, 17.6; range, 0-38.5%) versus 33.3% (95% CI 25.3, 43.9) for brentuximab vedotin (p < 0.0001). In sensitivity analyses, the estimated overall CR rates for historical/experimental agents were 13.6% (95% CI 8.7, 21.4) when only HL trials that reported a CR rate of >0% were included (13 studies; n = 696; p = 0.0009 vs. brentuximab vedotin), and 9.0% (95% CI 4.9, 16.6) when only HL trials were included where CR definition was reported and was measured using the same criteria as in the SG035-0003 study (12 studies; n = 562; p = 0.0001 vs. brentuximab vedotin). CONCLUSIONS Indirect comparisons against a heterogeneous historical sample population naturally limit our ability to draw comparisons, yet the results from this quantitative meta-analysis suggest that the antitumor activity of brentuximab vedotin may exceed that of other therapies used to treat patients with relapsed/refractory Hodgkin lymphoma post-ASCT.
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Affiliation(s)
- Vijayveer Bonthapally
- Global Outcomes and Epidemiology Research, Millennium: The Takeda Oncology Company , Cambridge, MA , USA
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Perales MA, Ceberio I, Armand P, Burns LJ, Chen R, Cole PD, Evens AM, Laport GG, Moskowitz CH, Popat U, Reddy NM, Shea TC, Vose JM, Schriber J, Savani BN, Carpenter PA. Role of cytotoxic therapy with hematopoietic cell transplantation in the treatment of Hodgkin lymphoma: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2015; 21:971-83. [PMID: 25773017 DOI: 10.1016/j.bbmt.2015.02.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/22/2022]
Abstract
The role of hematopoietic cell transplantation (HCT) in the therapy of Hodgkin lymphoma (HL) in pediatric and adult patients is reviewed and critically evaluated in this systematic evidence-based review. Specific criteria were used for searching the published literature and for grading the quality and strength of the evidence and the strength of the treatment recommendations. Treatment recommendations based on the evidence are included and were reached unanimously by a panel of HL experts. Both autologous and allogeneic HCT offer a survival benefit in selected patients with advanced or relapsed HL and are currently part of standard clinical care. Relapse remains a significant cause of failure after both transplant approaches, and strategies to decrease the risk of relapse remain an important area of investigation.
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Affiliation(s)
- Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Izaskun Ceberio
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Hematology Department, Hospital Universitario Donostia, Donostia, Spain
| | - Philippe Armand
- Division of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Linda J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Robert Chen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California
| | - Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine and Department of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, New York
| | - Andrew M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California
| | - Craig H Moskowitz
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas C Shea
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Julie M Vose
- Division of Hematology/Oncology, The Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey Schriber
- Cancer Transplant Institute, Virginia G Piper Cancer Center, Scottsdale, Arizona
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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21
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Macalalad AR, McAuliffe M, Yang H, Kageleiry A, Zhong Y, Wu EQ, Shonukan O, Bonthapally V. The epidemiology and targeted therapies for relapsed and refractory CD30+ lymphomas. Curr Med Res Opin 2015; 31:537-45. [PMID: 25598441 DOI: 10.1185/03007995.2015.1008131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL) both have consistent expression of CD30, a cytokine receptor that is expressed by activated T and B cells but is largely absent from normal tissue. METHODS A literature search was conducted via PubMed, Google Scholar, and UpToDate to identify relevant peer-reviewed original research or review articles on HL, sALCL, and CD30 targeted therapies. RESULTS These lymphomas are both more common among males, young adults and the elderly. Although many patients with HL and sALCL can achieve long-term remission after standard first-line therapy, up to a third of these patients are refractory to or relapse after initial therapy. Among these relapsed/refractory patients, many experience disease progression and/or death despite subsequent treatment, and treatment-related adverse events and mortality are not uncommon. To address the need for safer and more effective therapies for these relapsed/refractory patients, researchers have developed therapies that specifically target CD30-expressing cells. Brentuximab vedotin, an antibody-drug conjugate that selectively delivers a toxic microtubule-disrupting agent to malignant cells with CD30 expression, is the first such therapy to be approved in the US and Europe. In clinical trials, brentuximab vedotin has demonstrated efficacy and safety in patients with HL after failure of autologous stem cell transplantation (ASCT), or after failure of at least two prior multi-agent chemotherapy regimens in patients who are not ASCT candidates, and in patients with sALCL after failure of at least one prior multi-agent chemotherapy regimen. CONCLUSION HL and sALCL are both CD30+ lymphomas, and therapies like brentuximab vedotin that target cells expressing CD30 hold promise for the treatment of these diseases.
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von Tresckow B, Müller H, Eichenauer DA, Glossmann JP, Josting A, Böll B, Klimm B, Sasse S, Fuchs M, Borchmann P, Engert A. Outcome and risk factors of patients with Hodgkin Lymphoma who relapse or progress after autologous stem cell transplant. Leuk Lymphoma 2014; 55:1922-4. [PMID: 24138304 DOI: 10.3109/10428194.2013.854888] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bastian von Tresckow
- Department I of Internal Medicine, University Hospital Cologne , Cologne , Germany
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23
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Collins GP, Parker AN, Pocock C, Kayani I, Sureda A, Illidge T, Ardeshna K, Linch DC, Peggs KS. Guideline on the management of primary resistant and relapsed classical Hodgkin lymphoma. Br J Haematol 2013; 164:39-52. [DOI: 10.1111/bjh.12582] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Graham P. Collins
- Department of Haematology; Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - Anne N. Parker
- HPC Transplant Programme; Beatson West of Scotland Cancer Centre; Glasgow UK
| | | | - Irfan Kayani
- Department of Nuclear Medicine; University College London Hospitals NHS Trust; London UK
| | - Anna Sureda
- Department of Haematology; Addenbrookes Hospital; Cambridge University; Cambridge UK
| | - Tim Illidge
- Institute of Cancer Sciences; University of Manchester; The Christie Hospital; Manchester UK
| | - Kirit Ardeshna
- Department of Haematology; University College London Hospitals NHS Trust; London UK
| | - David C. Linch
- Department of Haematology; University College London Hospitals NHS Trust; London UK
- Department of Haematology; UCL Cancer Institute; University College London; London UK
| | - Karl S. Peggs
- Department of Haematology; University College London Hospitals NHS Trust; London UK
- Department of Haematology; UCL Cancer Institute; University College London; London UK
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25
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Martínez C, Canals C, Sarina B, Alessandrino EP, Karakasis D, Pulsoni A, Sica S, Trneny M, Snowden JA, Kanfer E, Milpied N, Bosi A, Guidi S, de Souza CA, Willemze R, Arranz R, Jebavy L, Hellmann A, Sibon D, Oneto R, Luan JJ, Dreger P, Castagna L, Sureda A. Identification of prognostic factors predicting outcome in Hodgkin's lymphoma patients relapsing after autologous stem cell transplantation. Ann Oncol 2013; 24:2430-4. [PMID: 23712545 DOI: 10.1093/annonc/mdt206] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for patients with relapsed Hodgkin's lymphoma (HL). However, there is currently little information on the predictors of outcome for patients whose disease recurs after ASCT. METHODS Five hundred and eleven adult patients with relapsed HL after ASCT from EBMT-GITMO databases were reviewed. RESULTS Treatments administered following ASCT failure included conventional chemotherapy and/or radiotherapy in 294 (64%) patients, second ASCT in 35 (8%), and alloSCT in 133 (29%). After a median follow-up of 49 months, overall survival (OS) was 32% at 5 years. Independent risk factors for OS were early relapse (<6 months) after ASCT, stage IV, bulky disease, poor performance status (PS), and age ≥50 years at relapse. For patients with no risk factors OS at 5 years was 62% compared with 37% and 12% for those having 1 and ≥2 factors, respectively. This score was also predictive for outcome in each group of rescue treatment after ASCT failure. CONCLUSION(S) Early relapse, stage IV, bulky disease, poor PS, and age ≥50 years at ASCT failure are relevant factors for outcome that may help to understand the results of different therapeutic approaches.
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Affiliation(s)
- C Martínez
- Hematology Department, Institute of Hematology and Oncology, Hospital Clinic, Barcelona, Spain.
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Czyz A, Romejko-Jarosinska J, Knopinska-Posluszny W, Nowicki A, Lojko-Dankowska A, Gil L, Dytfeld D, Walewski J, Hellmann A, Komarnicki M. Treatment strategy based on gemcitabine-containing salvage chemotherapy used with intent to proceed to second stem cell transplant for patients with Hodgkin lymphoma relapsing after a prior autologous transplant. Leuk Lymphoma 2012; 54:973-8. [PMID: 23025342 DOI: 10.3109/10428194.2012.734612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report is an analysis of patients with Hodgkin lymphoma who relapsed after autologous stem cell transplant (autoHCT) and who were treated with gemcitabine-based therapy as a bridge to either allogeneic or second autologous transplant. Sixteen patients were treated with gemcitabine, cisplatin and steroid and 21 with gemcitabine plus vinorelbine. The overall response rate was 68%. The grade 3-4 toxicity was myelosupression and infections. Fifteen patients proceeded to allogeneic and five to autologous transplant. Two-year overall survival (OS) and progression-free survival (PFS) for all patients were 36% and 25%, respectively. In multivariate analysis, relapse > 6 months after autoHCT and response to gemcitabine-based chemotherapy were associated with superior OS and response to gemcitabine-based chemotherapy with improved PFS. A treatment strategy based on gemcitabine-containing chemotherapy and second transplant appears to be an effective treatment option for patients relapsing > 6 months after autoHCT, providing a median survival time of 34 months.
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Affiliation(s)
- Anna Czyz
- Department of Hematology, Poznan University of Medical Sciences, Poznan, Poland.
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27
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Ziakas PD, Poulou LS, Voulgarelis M, Thanos L. The Gordian knot of interim 18-fluorodeoxyglucose positron emission tomography for Hodgkin lymphoma: a meta-analysis and commentary on published studies. Leuk Lymphoma 2012; 53:2166-74. [DOI: 10.3109/10428194.2012.685730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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