Citations 2
Overall survival of patients with cHL who progress after autologous stem cell transplant: results in the novel agent era
Desai, Sanjal H. , Evens, Andrew M. , Šýkorová, Alice , Bachanová, Veronika , Goyal, Gaurav , Dorritie, Kathleen , Azzi, Jacues, Kenkre, Vaishalee P. , Chang, Cheryl , Michalka, Jozef , Ansell, Stephen M. , Fusco, Brendon , Hatic, Haris, Saba, Raya , Harris, Elyse I., Wagner‐Johnston, Nina D. , Arai, Sally , Nowakowski, Grzegorz S. , Móciková, Heidi , Jagadeesh, Deepa , Blum, Kristie A. , Diefenbach, Catherine , Iyengar, Siddharth , Rappazzo, Katherine , Choi, Yun Young , Advani, Ranjana H. , Micallef, Ivana N. , Evens, Andrew M , Goyal, Guarav , Dorritie, Kathleen , Sumransub, Nuttavut , Ibrahim, Uroosa , Wagner-Johnston, Nina , Arai, Sally , Mocikova, Heidi , Prochazka, Vit , Micallef, Ivana, Bachanova, Veronika , Advani, Ranjana H , Desai, Sanjal , Diefenbach, Catherine S , Spinner, Michael A. , Kahl, Brad S. , Shah, Harsh , Baidoun, Firas , Procházka, Vít
Blood Advances | September 20, 2023 | Volume: 7 | Issue: 23 | Pages: 7295-7303
10.1182/bloodadvances.2023011205
Abstract In the pre–novel agent era, the median postprogression overall survival (PPS) of patients with classic Hodgkin lymphoma (cHL) who progress after autologous stem cell transplant (ASCT) was 2 to 3 years. Recently, checkpoint inhibitors (CPI) and brentuximab vedotin (BV) have improved the depth and durability of response in this population. Here, we report the estimate of PPS in patients with relapsed cHL after ASCT in the era of CPI and BV. In this multicenter retrospective study of 15 participating institutions, adult patients with relapsed cHL after ASCT were included. Study objective was postprogression overall survival (PPS), defined as the time from posttransplant progression to death or last follow-up. Of 1158 patients who underwent ASCT, 367 had progressive disease. Median age was 34 years (range, 27-46) and 192 were male. Median PPS was 114.57 months (95% confidence interval [CI], 91-not achieved) or 9.5 years. In multivariate analysis, increasing age, progression within 6 months, and pre-ASCT positive positron emission tomography scan were associated with inferior PPS. When adjusted for these features, patients who received CPI, but not BV, as first treatment for post-ASCT progression had significantly higher PPS than the no CPI/no BV group (hazard ratio, 3.5; 95% CI, 1.6-7.8; P = .001). Receipt of allogeneic SCT (Allo-SCT) did not improve PPS. In the era of novel agents, progressive cHL after ASCT had long survival that compares favorably with previous reports. Patients who receive CPI as first treatment for progression had higher PPS. Receipt to Allo-SCT was not associated with PPS in this population.
Outcomes of classic Hodgkin lymphoma, relapsed within one year of diagnosis, in the era of novel agents.
David, Kevin A. , Saba, Raya , Dorritie, Kathleen , Harris, Elyse I., Fusco, Brendon , Hatic, Haris, Iyengar, Siddharth , Rappazzo, Katherine , Micallef, Ivana N. , Desai, Sanjal H. , Spinner, Michael A. , Bachanová, Veronika , Goyal, Gaurav , Azzi, Jacques Mario , Sumransub, Nuttavut , Ibrahim, Uroosa , Baidoun, Firas , Orellana‐Noia, Victor M. , Diefenbach, Catherine , Advani, Ranjana H.
Journal of Clinical Oncology | June 6, 2022 | Volume: 40 | Issue: 16_suppl | Pages: 7515-7515
10.1200/jco.2022.40.16_suppl.7515
7515 Background: Primary refractory disease (PRD) and early relapse (ER) are predictors of poor prognosis in classic Hodgkin lymphoma (cHL). In this multicenter retrospective study, we describe outcomes of PRD and ER in pts with relapsed/refractory (R/R) cHL treated with salvage therapy (ST) and autologous stem cell transplant (ASCT). Methods: Of 14 sites, adult patients with R/R cHL who received ST and underwent ASCT were enrolled. PRD was defined as progression on frontline chemoimmunotherapy or within 6 months of diagnosis. ER was defined as relapse from 6 months-1 yr of diagnosis. Pts who relapsed >1 yr of diagnosis were called late relapses (LR). Study objectives were Overall response rates (ORR), CR rates, PFS, and OS. Results: Of 986 total pts, 160 had PRD, 365 had ER and 461 had LR. Significantly higher number of pts with PRD, but not ER, had bulky disease (41% vs 27%, p<0.01) and B symptoms (53% vs 38%, p<0.001) than LR. Higher proportions of pts with PRD and ER required >1 line of ST (44% vs 30% vs 23%, p<0.001) before ASCT and received BV maintenance (25% vs 24% vs 16%, p<0.05). When adjusted for B symptoms and Bulky disease, PRD and ER had significantly lower ORR (65% vs 76% vs 84%, p<0.001) and CR (37% vs 46% vs 57%, p<0.001) to first ST than LR. Pts with PRD and ER had significantly lower PFS (56.3%, 61.4%, vs 77.6%, p<.0001) and OS (93% vs 89% vs 94%, p=0.01) than LR. In pts with ER, Brentuximab/bendamustine (BBV) and brentuximab vedotin/nivolumab (BV/nivo) had a trend towards higher ORR (92% vs 92% vs 75%) but significantly higher CR (79.2% vs 76% vs 42%, p<0.01) than platinum based chemotherapy (PBC). In pts with PRD, BBV and BV/Nivo had a statistically insignificant trend towards higher ORR and CR than PBC. The table shows 2 yr PFS by type of ST in PRD, ER, LR. There was no difference in PFS by time to relapse in BV/nivo, CPI and miscellaneous agents. BV/Nivo had a significantly higher PFS than PBC in PRD (88% vs 48%, p<0.05) and ER (95% vs 57%, p<0.05). There was no difference in PFS of PBC and other ST in PRD, ER or LR. OS was not significantly associated with type of ST in either group. Conclusions: PRD and ER are associated with lower response to ST and survival after ASCT compared to late relapse. In pts with PRD and ER, BV/Nivo has high ORR and CR and leads to significantly higher PFS comparable to pts with late relapse and may be preferable ST regardless of time to relapse. [Table: see text]