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

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.

Brentuximab vedotin in relapsed or refractory classical hodgkin lymphoma: real life experience in Norway 2011–2016

“…However, other studies have suggested that the higher responses rates and more favorable toxicity profile of BV compared to historical salvage regimens may render more patients suitable for an allogeneic transplant. A recent national study from Greece with a similar design also found a higher rate of allogeneic SCT and improved survival in patients treated with BV for a post-ASCT relapse, even when censoring at time of the second SCT [10].…”

“…Following approval of BV, real-world experience in patients with post-ASCT relapse has supported the early data, and a number of patients may be candidates for a second, mostly allogeneic stem cell transplant (SCT) [6][7][8]. No randomized comparison for patients with post-ASCT has been performed, but a real-world comparison of BV versus other chemotherapeutic regimens and registry data have indicated a benefit for BV [9,10].…”

Optimizing outcomes in relapsed/refractory Hodgkin lymphoma: a review of current and forthcoming therapeutic strategies

“…126 Although the potential effect of BV on the OS of patients who have failed autoSCT cannot be strictly estimated in the absence of randomized trials, it appears that an OS benefit has probably been achieved. 157,158 OS rates in the BV era appear better than prior to its introduction, and this persists when only the 'worst-case scenario' is taken into account. 158 Brentuximab vedotin as a bridge to autoSCT after inadequate response to salvage therapy.…”

“…157,158 OS rates in the BV era appear better than prior to its introduction, and this persists when only the 'worst-case scenario' is taken into account. 158 Brentuximab vedotin as a bridge to autoSCT after inadequate response to salvage therapy. This topic has already been discussed above in the section 'Bridging autoSCT with novel agents in chemorefractory patients'.…”

Treatment of Hodgkin Lymphoma – New and Developing Therapies and Their Potential Role in Standard of Care

“…[49][50][51][52][53][54][55] Although difficult to assess, recent real-world data suggest that the introduction of brentuximab vedotin in the post-ASCT relapsed/refractory setting may improve overall survival compared with previous standards of care. 55,56 Importantly, the pivotal trial demonstrated that a small, but not negligible, minority of patients with relapsed/refractory Hodgkin lymphoma failing ASCT may achieve long-term CR and thus reach potential cure with up to 16 infusions of brentuximab vedotin monotherapy. [46][47][48] Following on from these results, in the phase III AETHERA trial, brentuximab vedotin significantly improved PFS after ASCT compared with placebo (median 42.9 versus 24.1 months; hazard ratio [HR]: 0.57; p=0.013), 29 and provided sustained benefits on PFS for at least 5 years (PFS at 5 years: 59% versus 41%; HR: 0.52 [95% CI 0.38-0.72]).…”