Abstract
CONTEXT: Brentuximab vedotin (Bv) improves PFS post autologous HCT in high risk relapsed/refractory classical Hodgkin Lymphoma (r/r cHL). We examined the impact of earlier incroporation of Bv within salvage chemotherapy followed by consolidation in high risk r/r cHL. PATIENTS OR OTHER PARTICIPANTS: Patients with high risk r/r cHL received Bv with salvage at 1.8 mg/kg on day 1 of each cycle. Post-HCT Bv consolidation was given starting day 30-45 at 1.8 mg/kg every 3 weeks for up to 16 cycles. Complete metabolic response was defined as deauville score u2264 3. Kaplan Meir curve estimates for PFS and OS were computed. RESULTS: A total of 20 patients were identified and all records retrospectively collected. Baseline characteristics were as follows; 11 (55%) male with median age at HCT of 22 years. 12 (60%) had refractory disease with median time to relapse following front line of 3.7 months. Bv was given with IGEV in 14 (70%), ESHAP in 4 (20%) and Bendamustine in 2 (10%). 14 (70%) of patients were in complete metabolic response pre-HCT. A total of 19 patients were collected during salvage with GCSF while the remaining patient was mobilized with GCSF alone. Median CD34 x106/kg collected was 12.75 (2.51-42.5) with median days to ANC and platelet recovery of 12 (9-15) and 16 (11-20), respectively. Post HCT, all patients received Bv consolidation with a median number of doses of 12 (3-16). Observed adverse events on Bv consolidation were; grade 3 neutropenia in 9 (45%) requiring GCSF support in all and dose reduction in 6 (30%), neuropathy grades 1-3 in 2 patients (15%), 3 (15%) and 1 (5%) leading to early discontinuation of planned consolidation in 4 (20%). Neuropathy resolved or improved in all cases. A total of 2 patients relapsed, both while on Bv consolidation. Median follow up was 15.4 months (3.8-56) with estimated 2-year PFS and OS of 83% and 95%, respectively. CONCLUSIONS: Use of Bv containing salvage regimens followed by post-HCT consolidation resulted in excellent outcomes in high risk r/r cHL and did not impact stem cell mobilization. Adverse events were common but manageable. Longer follow up and further validation of these observations are warranted.