Brentuximab vedotin followed by bendamustine supercharge for refractory or relapsed Hodgkin lymphoma

Abstract

Key Points FDG-PET–negative status achieved with salvage therapy is the most important determinant of favorable outcome after HSCT, for patients with R/R cHL. Our modified Bv+Bs salvage regimen led to deep metabolic responses in the majority of patients, establishing a bridge to transplant.

Brentuximab vedotin in association with bendamustine in refractory or multiple relapsed Hodgkin lymphoma. A retrospective real‐world study

“…Although the toxicity of BvB in our experience has been manageable, 11% of patients discontinued therapy for toxic events and 11% had infections, caused by viral reactivation (5 Herpes Zooster, 1 CMV pneumonitis, 1 HCV reactivation). A high incidence of CMV reactivation and fever (5 patients: 25%) was also reported by Picardi 42. Differences in adherence to viral prophylaxis or the inclusion of more heavily pretreated patients could account for the registration of this toxicity in retrospective studies.…”

“…In conclusion, our real-life experience confirms that BvB is effective in RR-cHL patients and is generally a well-tolerated therapeutic regimen. 35,36,42,43 However, in our experience, the reported toxicity has been significant, particularly for the risk of viral reactivation, and careful monitoring and antiviral prophylaxis is highly advisable.…”

“…Notably, at variance with our retrospective analysis, patients previously exposed to Bv or bendamustine, as well as those in relapse beyond second‐line treatment, were excluded from the abovementioned prospective studies. Picardi published the results of a small retrospective study with a modified BvB version, including a bendamustine supercharge (ie, 120 mg/m 2 ) on 20 patients with RR‐cHL. They report a remarkable CR rate (80%) with PET‐negative scans and 2‐year PFS (93.7%).…”

The addition of bendamustine to brentuximab vedotin leads to improved rates of complete metabolic remission in children, adolescents and young adults with relapsed and refractory classical Hodgkin lymphoma: a retrospective single‐centre series

“…Single‐agent bendamustine achieved a CMR rate of 33% in adults with R/R cHL 5 . While there are no randomised comparisons, a number of studies have reported higher CR/CMR rates with the combination of Bv plus bendamustine (Bv + B) in adults, than with either agent alone 2,6–11 . A phase 1/2 study of 55 adults with R/R cHL reported a CR rate of 74%, with PFS at three years of 60%, in patients undergoing ASCT 6 .…”

First salvage treatment with bendamustine and brentuximab vedotin in Hodgkin lymphoma: a phase 2 study of the Fondazione Italiana Linfomi

“…Importantly, an optional post-ASCT maintenance phase with single-agent BV was planned in the trial by LaCasce et al, which was not part of the treatment in our study: this may have impacted on the survival outcomes of patients not receiving an ASCT consolidation 19 . High remission rates and promising long-term survival results have been equally shown with the same combination in patients failing more than one previous line of therapy, including some heavily pretreated patients 20,21 .…”