1.
Improved outcomes of high-risk relapsed Hodgkin lymphoma patients after high-dose chemotherapy: a 15-year analysis
Nieto, Y., Gruschkus, S., Valdez, B. C., Jones, R. B., Anderlini, P., Hosing, C., Popat, U., Qazilbash, M., Kebriaei, P., Alousi, A., et al
Haematologica. 2021
Abstract
High-dose chemotherapy and autologous stem-cell transplant (HDC/ASCT) is standard treatment of chemosensitive relapsed classical Hodgkin lymphoma (cHL), although outcomes of high-risk relapse (HRR) patients remain suboptimal. We retrospectively analyzed all HRR cHL patients treated with HDC/ASCT at our institution between 01/01/2005-12/31/2019. HRR criteria included primary refractory disease/relapse within 1 year, extranodal extension, B symptoms, requiring > 1 salvage line, or PET+ disease at ASCT. All patients met the same ASCT eligibility criteria. We treated 501 patients with BEAM (N=146), BuMel (N=38), GemBuMel (N=189) and vorinostat/GemBuMel (N=128). The GemBuMel and vorinostat/GemBuMel cohorts had more HRR criteria and more patients with PET+ disease at ASCT. Pre-ASCT BV, anti-PD1, PET-negative disease at ASCT, and maintenance BV increased over time. BEAM and BuMel predominated in earlier years (2005-2007), GemBuMel and BEAM in middle years (2008-2015), and vorinostat/GemBuMel and BEAM in later years (2016-2019). Median follow-up is 50 months (6-186). Outcomes improved over time, with 2-year PFS/OS rates of 58%/82% (2005-2007), 59%/83% (2008-2011), 71%/94% (2012-2015) and 86%/99% (2016-2019) (P.
2.
Phase II Trial of High-Dose Gemcitabine/Busulfan/Melphalan with Autologous Stem-Cell Transplantation for Primary Refractory or Poor-Risk Relapsed Hodgkin's Lymphoma
Nieto, Y., Thall, P. F., Ma, J., Valdez, B. C., Ahmed, S., Anderlini, P., Popat, U., Jones, R. B., Shpall, E. J., Hosing, C., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
We conducted a prospective phase 2 trial of gemcitabine, busulfan and melphalan (Gem/Bu/Mel) with autologous stem-cell transplantation (ASCT) in Hodgkin's lymphoma (HL) patients with primary refractory or poor-risk relapsed disease (extranodal relapse or within 1 year of frontline therapy). The trial was powered to detect a 2-year progression-free survival (PFS) rate improvement from a historical 50% (using BEAM) to 65%. We compared the study population with all other concurrent patients who were eligible for the trial but instead received BEAM at our center. No patient received post-ASCT maintenance. The Gem/Bu/Mel trial enrolled 80 patients: median age 31, 41% primary refractory and 59% relapsed (36% extranodal relapses), and 30% PET-positive lesions at ASCT. The concurrent BEAM (N=45) and Gem/Bu/Mel cohorts were well balanced except for more Gem/Bu/Mel patients with bulky relapses and PET-positive tumors. There were no transplant-related deaths in either cohort. At median follow-up of 34.5 months (range, 26-72), Gem/Bu/Mel resulted in improved 2-year PFS (65% vs. 51%) (P=0.008) and overall survival (89% vs. 73%, P=0.0003). In conclusion, Gem/Bu/Mel is safe, yielding, in this nonrandomized comparison, improved outcomes compared with a concurrently treated and prognostically matched cohort of primary refractory or poor-risk relapsed HL patients receiving BEAM.