Brentuximab vedotin and bendamustine as salvage therapy for primary refractory or relapsed H odgkin lymphoma: A multicentre experience of the P olish lymphoma research group

Abstract

Introduction: An optimal therapy for patients with primary refractory or relapsed (R/R) Hodgkin lymphoma (HL) who did not respond to standard salvage chemotherapy has not been established. Brentuximab vedotin (BV) and bendamustine (B) used in monotherapy both have shown to be active in R/R HL and both are included in therapy options in these clinical settings. However, the combination of BV with B (BVB) has been investigated in only few clinical trials. Here, we report our experience of BVB given to patients with R/R HL. Methods: Since March 2015, the patients with R/R HL treated at one of the centers involved in the present retrospective analysis were considered to receive BVB (BV 1.8 mg/kg on day 1 and B 90 mg/m2 on days 1 and 2 of a treatment cycle repeated every 21 days). The choice of BBV as salvage therapy was based on the decision of the responsible physician. Results: Between March 2015 and February 2017, BVB regimen was administered to 24 patients (median age, 33 years; range, 18‐60) with primary refractory (n = 8) or relapsed HL (n = 16), who were treated with a median of 3.5 (range, 2‐12) prior chemotherapy lines. Ten of 24 patients were given BVB for relapse after autologous stem cell transplant (SCT), and 4 for relapse after allogeneic SCT preceded by autologous SCT. The patients received a median of 2 (range, 1‐6) BVB courses. The toxicities of a total 66 BVB cycles were analyzed. The grade 3‐4 toxicities were myelosupression and infections. Grade 3‐4 neutropenia occurred in 2 (8%) and thrombocytopenia <75 G/L in 3 patients (12%). Two of 66 cycles (3%) in 2 patients (8%) were complicated by pneumonia. There were 2 early deaths, 1 due to progression of HL, and 1 due to pneumonia in a patient treated after allogeneic SCT. The overall response rate was 82%, with 10 (41%) complete and 10 (41%) partial metabolic response assessed by positron emission tomography. After a median follow‐up of 12 months (range, 2‐24), 20 patients remain alive. Fifteen of them are in complete remission. Four patients have proceeded to autologous SCT and other 4 to allogeneic SCT. The probability of overall survival for the whole group at 18 months is 74% (95% CI, 47‐90). The estimated median progression‐free survival time is 14 months (95% CI, 10‐19) (Figure). Conclusions: Our experience suggests that BVB is a feasible regimen with acceptable toxicity profile and significant response rate in heavily pretreated patients with R/R HL. Moreover, these results indicate that BVB may be successfully used as a bridge to SCT and warrant further (Figure Presented) studies to compare prospectively the efficacy of BVB with BV in monotherapy in R/R HL.