Efficacy of brentuximab consolidation by metabolic response in an international real‐world cohort of classic Hodgkin lymphoma at high risk for progression after ASCT
Year: 2023
Type: article
Study design: Observational Study
Abstract: Background: Salvage chemotherapy and autologous stem cell transplant (ASCT) have cure rates of 60–70% in relapsed refractory (R/R) classic Hodgkin lymphoma (cHL). Pre-ASCT compete metabolic response (CMR) compared to partial metabolic response (PMR), is associated with significantly better progression free survival (PFS) and overall survival (OS). Post-ASCT brentuximab vedotin (BV) consolidation improves PFS in pts with high-risk relapse as per ATHERA criteria: early relapse [ER], primary refractory disease [PRD] or extra nodal disease (END). Impact of BV consolidation by pre-ASCT PET-based response is not well characterized. Here we report outcomes of BV consolidation on PFS and OS by pre-ASCT PET-based response in real world cohort of R/R cHL. Methods: From a multicenter, international, observational cohort of 15 institutions of US and Czech Republic, adult pts with cHL and high-risk relapse per ATHERA criteria, who had ASCT were included in this study. Demographics, time to relapse, extranodal disease, B symptoms, stage, lines of salvage therapies, ASCT era, BV consolidation were collected. Pre-ASCT metabolic response was determined institutionally according to PET-based Lugano criteria. Study objectives were PFS and OS from date of ASCT. Association of BV consolidation with PFS and OS was assessed in the subgroup of pre-ASCT CMR and PMR using propensity score weighted analysis. Results: Out of 1158 pts enrolled from January 2011 to December 2020, 880 met ATHERA criteria. Median age was 32 (12–72), 473 (54%) were male, 511 (59%) had advanced stage, 389 (45%) had END, 385 (45%) had B symptoms, 266 (30%) had PRD, 484 (55%) had ER, and 259 (29%) required ≥2 line of salvage pre-ASCT. 527 (60%) had CMR and 222 (25%) had PMR pre-ASCT. 208 received BV consolidation. Median follow up was 37 (0.3–137) months. In all pts, 2-yr PFS was 64% (CI95: 61–68) and OS was 90% (CI95: 88–93). Receipt of BV consolidation was associated with significantly higher 2 yr PFS (HR: 0.7, CI95: 0.5–0.9, p = 0.0002) and OS (0.4, CI95: 0.1–0.9, p = 0.0002) compared with no BV maintenance. In univariate analysis, increasing age and salvage therapy lines, ER, PRD, END, accounting for age, relapse <12 months, PRD, extranodal disease, salvage therapy lines and ASCT era, BV consolidation was not significantly associated with PFS (0.7, CI95: 0.4–1.2, p = 0.1) or OS (0.5, CI95: 0.2–1.4, p = 0.2) in the group of pts with pre-ASCT CMR. In pts with pre-ASCT PMR, BV consolidation was associated with higher PFS (0.5, CI95: 0.3–0.9, p = 0.01) and OS (0.4, CI95: 0.1–0.8, p = 0.02). The research was funded by: Czech Republic dataset was supported by grant NU22-03-00182 Keyword: Hodgkin lymphoma Conflicts of interests pertinent to the abstract. S. H. Desai Honoraria: Seattle Genetics K. A. Blum Research funding: BMS and Seattle Genetics
Source: Hematological Oncology
DOI: 10.1002/hon.3164_260
Authors: S. H. Desai, A. Smith, M. Spinner, A. Sykorova, V. Bachanova, A. M. Evens, G. Goyal, B. Kahl, K. Dorritie, J. Azzi, V. P. Kenkre, C. Chang, J. Michalka, B. Fusco, N. Sumransub, H. Hatic, R. Saba, U. Ibrahim, E. I. Harris, H. Shah, N. Wagner‐Johnston, S. Arai, H. Mockikova, D. Jagadeesh, K. A. Blum, C. Diefenbach, S. Geyer, S. Iyenger, K. Rapazzo, F. Baidoun, Y. Choi, R. H. Advani, V. Prochazka, I. Micallef
Institutions: University of Minnesota, Mayo Clinic, University of California, San Francisco, Charles University, Rutgers Cancer Institute, University of Alabama at Birmingham, Washington University in St. Louis, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Icahn School of Medicine at Mount Sinai, University of Wisconsin–Madison, Stanford Medicine, Masaryk University, University of Utah, Huntsman Cancer Institute, Johns Hopkins University, Johns Hopkins Hospital, Sidney Kimmel Comprehensive Cancer Center, Cleveland Clinic, Emory University, Winship Cancer Institute, NYU Langone’s Laura and Isaac Perlmutter Cancer Center, New York University, Palacký University Olomouc
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4380083594