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Contemporary outcomes of high risk relapsed refractory classical hodgkin lymphoma patients—role of maintenance therapy in the real world

Bone Marrow Transplantation volume 58, pages 1160–1162 (2023)Cite this article

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Standard treatment for transplant eligible relapsed or refractory classical Hodgkin lymphoma (r/r cHL) patients involves high-dose chemotherapy, followed by autologous hematopoietic stem cell transplantation (HCT). Approximately, half of those patients attain long term remissions and likely cured [1, 2]. Relapse remains the most common cause of treatment failure after HCT. Patients with primary refractory disease, early relapse (<12 months) or with extra-nodal disease at relapse are at high risk of transplant failure [3, 4]. The use of the CD30 conjugated monoclonal antibody brentuximab vedotin (Bv) as maintenance post HCT can mitigate such risk as shown in the AETHERA trial [5]. The aim of this analysis is to examine the outcome of r/r cHL patients treated with Bv post-HCT.

After due institutional review board (IRB) approval, high-risk r/r cHL patientsthat underwent HCT at our facility between 2010 and 2020 were evaluated. Prior to HCT, patients received salvage chemotherapy, the choice of which was left to the treating physician discretion. BEAM (carmustine, etoposide, cytarabine, and melphalan) was administered to patients as the conditioning regimen before autologous stem cell rescue. Deauville score of ≤3 was regarded complete metabolic response (CMR) pre-HCT. Starting in 2014, Bv was given as maintenance for up to 16 cycles, including any pre-HCT therapy. Categorical and continuous variables were compared using Pearson’s chi-squared and Wilcoxon/Kruskal-Wallis, respectively. Overall survival was calculated from the date of transplant until death or loss of follow-up. Progression free survival (PFS) was calculated from the time of transplant until death or disease progression/relapse. Overall survival (OS) and progression free survival (PFS) were computed using Kaplan-Meir method with log rank test. Multivariable analysis was computed using cox regression incorporating variables with p value < 0.15 at univariable analysis.

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Fig. 1: Outcome post autologous HSCT relapsed or refractory classical Hodgkin lymphoma.

References

  1. Majhail NS, Farnia SH, Carpenter PA, Champlin RE, Crawford S, Marks DI, et al. Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the american society for blood and marrow transplantation. Biol Blood Marrow Transpl. 2015;21:1863–9.

    Article  Google Scholar 

  2. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet. 2002;359:2065–71.

    Article  CAS  PubMed  Google Scholar 

  3. Devillier R, Coso D, Castagna L, Brenot Rossi I, Anastasia A, Chiti A, et al. Positron emission tomography response at the time of autologous stem cell transplantation predicts outcome of patients with relapsed and/or refractory Hodgkin’s lymphoma responding to prior salvage therapy. Haematologica. 2012;97:1073–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Moskowitz CH, Matasar MJ, Zelenetz AD, Nimer SD, Gerecitano J, Hamlin P, et al. Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. Blood. 2012;119:1665–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Moskowitz CH, Walewski J, Nademanee A, Masszi T, Agura E, Holowiecki J, et al. Five-year PFS from the AETHERA trial of brentuximab vedotin for Hodgkin lymphoma at high risk of progression or relapse. Blood. 2018;132:2639–42.

    Article  CAS  PubMed  Google Scholar 

  6. Hahn T, McCarthy PL, Carreras J, Zhang MJ, Lazarus HM, Laport GG, et al. Simplified validated prognostic model for progression-free survival after autologous transplantation for hodgkin lymphoma. Biol Blood Marrow Transpl. 2013;19:1740–4.

    Article  Google Scholar 

  7. Damlaj M, Ghazi S, Syed G, Pasha T, Gmati G, Salama H, et al. Pre-autologous transplantation PET/CT using Deauville criteria is an independent predictor of progression in relapsed refractory classical Hodgkin lymphoma. Bone Marrow Transpl. 2017;52:1342–4.

    Article  CAS  Google Scholar 

  8. Schot BW, Zijlstra JM, Sluiter WJ, van Imhoff GW, Pruim J, Vaalburg W, et al. Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma. Blood. 2007;109:486–91.

    Article  CAS  PubMed  Google Scholar 

  9. Armand P, Chen YB, Redd RA, Joyce RM, Bsat J, Jeter E, et al. PD-1 blockade with pembrolizumab for classical Hodgkin lymphoma after autologous stem cell transplantation. Blood. 2019;134:22–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia

    Moussab Damlaj, Bader Alahmari, Husam AlSadi, Mazin Ahmed, Zied AlJubour, Ayman Alhejazi, Hend Salama, Ayman Ibrahim, Abdulrahman Al Raizah, Mohammed Bakkar, Abdulraouf Ghori, Ahmed Alaskar & Mohsen Alzahrani

  2. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Moussab Damlaj, Bader Alahmari, Ayman Alhejazi, Hend Salama, Ayman Ibrahim, Abdulrahman Al Raizah, Mohammed Bakkar, Abdullah S. Al Saleh, Ahmed Alaskar & Mohsen Alzahrani

  3. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Moussab Damlaj, Bader Alahmari, Ayman Alhejazi, Hend Salama, Ayman Ibrahim, Abdulrahman Al Raizah, Mohammed Bakkar, Abdullah S. Al Saleh, Ahmed Alaskar & Mohsen Alzahrani

  4. Sheikh Shakhbout Medical City, Abu Dhabi, UAE

    Moussab Damlaj

  5. Khalifa University, Abu Dhabi, UAE

    Moussab Damlaj

  6. Alfaisal University, Riyadh, Saudi Arabia

    Mohamed Tlayjeh

  7. American University of Beirut, Beirut, Lebanon

    Ahmad Damlaj

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Contributions

MD: Designed the study, collected the data, analyzed the data and wrote the paper. MT, AD: Designed the study and wrote the paper. BA, HA, MA, ZA, AA, HS, AI, AAR, MB, AG, ASA, AA, MA: Designed the study, provided study subjects and wrote the paper.

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Correspondence to Moussab Damlaj.

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Damlaj, M., Tlayjeh, M., Damlaj, A. et al. Contemporary outcomes of high risk relapsed refractory classical hodgkin lymphoma patients—role of maintenance therapy in the real world. Bone Marrow Transplant 58, 1160–1162 (2023). https://doi.org/10.1038/s41409-023-02036-x

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