Treatment of Hodgkin Lymphoma Relapsed after Autologous Stem Cell Transplantation

Abstract

Although autologous stem cell transplantation (auto-HCT) is the standard of care for patients with refractory/relapsed (R/R) classical Hodgkin’s lymphoma (cHL), there is still a significant proportion of patients that relapse after the procedure. This review contemplates different treatment strategies for patients with cHL that relapse or progress after auto-HCT. Allogeneic stem cell transplantation (allo-HCT) has, for many years, been the only curative option for this group of patients. Although the advent of haploidentical donors has allowed for the possibility to allograft almost all patients that are in need of it and to eventually improve historical results, allo-HCT is still associated with substantial morbidity and mortality. Brentuximab vedotin (BV) is an antibody drug conjugate that binds to CD30 antigen; BV is able to give up to 34% metabolic complete remissions (mCR) in HL patients that fail auto-HCT. Unleashing the immune system with PD-1 inhibitors has resulted in remarkable responses in a number of malignancies, including HL. Nivolumab and pembrolizumab offer a 20%–25% mCR and 40%–50% partial remissions, with an acceptable safety profile. R/R cHL do have several options nowadays that, without any doubt, have significantly improved the long-term outcome of this hard-to-treat population.

Biomodulatory Treatment Regimen, MEPED, Rescues Relapsed and Refractory Classic Hodgkin’s Disease

“…Although approved standard treatments are highly efficacious, cumulative toxicity and treatment-associated malignancies remain a therapeutic challenge in cHL (Rueda et al, 2015;van Leeuwen and Ng, 2016;Borchmann et al, 2018;Mehta-Shah and Bartlett, 2018;Moskowitz et al, 2019;Domingo-Domènech and Sureda, 2020). Since cHL is frequently occurring in younger adults these long-term adverse effects need to be addressed for further advancing therapy.…”

CAR-T Cell Therapy for Classical Hodgkin Lymphoma

“…), an immunoconjugate of a monoclonal antibody to CD25 with cytotoxin pyrrolobenzodiazepine (Camidanlumab tesirine), a bispecific antibody to CD16 and CD30 (AFM13) and adoptive cellular immunotherapy (including Chimeric antigen receptor T cell [CAR-T cell] therapy). 7…”

“…), an immunoconjugate of a monoclonal antibody to CD25 with cytotoxin pyrrolobenzodiazepine (Camidanlumab tesirine), a bispecific antibody to CD16 and CD30 (AFM13) and adoptive cellular immunotherapy (including Chimeric antigen receptor T cell [CAR-T cell] therapy). 7 Following advances in clinical trials and FDA approval of anti-CD19 CAR-T cell therapies for non-Hodgkin's lymphomas and B-ALL, as well as an anti-B-cell maturation antigen (BCMA) CAR-T cell therapy for multiple myeloma, there is a growing interest in the scientific community to explore the potential of CAR-T cell therapy in cHL. CAR-T cell technology overview is out of the scope of this article, it is discussed elsewhere.…”

“…New approaches in the treatment of cHL include the use of Bruton’s tyrosine kinase inhibitors, JAK2 inhibitors, immunomodulatory drugs (lenalidomide, etc. ), an immunoconjugate of a monoclonal antibody to CD25 with cytotoxin pyrrolobenzodiazepine (Camidanlumab tesirine), a bispecific antibody to CD16 and CD30 (AFM13) and adoptive cellular immunotherapy (including Chimeric antigen receptor T cell [CAR‐T cell] therapy) 7 …”

Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

“…Hodgkin lymphoma (HL) is a haematological malignancy that accounts for about 10% of all lymphomas [ 1 , 2 ]. Although most patients with HL are cured with initial therapy, up to 20–30% of patients with advanced HL are refractory to initial therapy or will relapse (R/R HL), requiring further therapeutic options [ 2 ]. Classical HL (cHL) is the most frequent type of HL.…”