CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(01): 23-28
DOI: 10.4103/ijmpo.ijmpo_64_19
Original Article

Analysis of Relapsed/Refractory Hodgkin Lymphoma Treated with Autologous Transplantation: A Single-Center Experience

Vishal Kulkarni
Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
,
Sulav Sapkota
Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
,
Girish V Badarkhe
Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
,
BJ Srinivas
Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
,
Radheshyam Naik
Department of Hematology and Medical Oncology, HCG Enterprises Ltd., Bengaluru, Karnataka, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Introduction: Hodgkin lymphoma (HL) is one of the common lymphomas with high cure rate. Aims: The aim was to study the outcome of relapsed/refractory HL treated with autologous transplantation. Objectives: The objective was to study the overall survival, overall response, and disease-free survival of the relapsed/refractory HL after autologous transplantation. Methods: It was a retrospective study conducted over a period of 8 years in our center using computer-based database and medical records as the data source. Results: A total of 22 patients were diagnosed with relapsed/refractory HL of which majority of cases were male patients (59%) with a mean age of 29 years (range: 15–57 years) and were Stage 4A (40.9%), with nodular sclerosis (54.5%). The overall response rate was 81.8% with 9.1% complete response, 72.7% partial response, and 4.5% stable disease; the overall survival was 77.92 ± 6.65 months, and disease-free survival was 69.66 ± 8.13 months. Conclusion: Autologous stem cell transplant plays an integral role in the treatment of patients with relapsed/refractory Hodgkin lymphoma.



Publication History

Received: 06 March 2019

Accepted: 24 November 2019

Article published online:
23 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Bonadonna G, Viviani S, Bonfante V, Gianni AM, Valagussa P. Survival in Hodgkin’s disease patients-report of 25 years of experience at the Milan Cancer Institute. Eur J Cancer 2005; 41: 998-1006
  • 2 Radford JA, Eardley A, Woodman C, Crowther D. Follow up policy after treatment for Hodgkin’s disease: Too many clinic visits and routine tests? A review of hospital records. BMJ 1997; 314: 343-6
  • 3 Lazarus HM, Rowlings PA, Zhang MJ, Vose JM, Armitage JO, Bierman PJ. et al. Autotransplants for Hodgkin’s disease in patients never achieving remission: A report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 1999; 17: 534-45
  • 4 André M, Henry-Amar M, Pico JL, Brice P, Blaise D, Kuentz M. et al. Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin’s disease induction failure: A case-control study. Société Francaise de Greffe de Moelle. J Clin Oncol 1999; 17: 222-9
  • 5 Goldschmidt N, Or O, Klein M, Savitsky B, Paltiel O. The role of routine imaging procedures in the detection of relapse of patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma. Ann Hematol 2011; 90: 165-71
  • 6 Krause SW, Gerken M, Andreesen R, Hofstädter F, Klinkhammer-Schalke M. Treatment of B cell lymphoma with chemotherapy plus rituximab: A survival benefit can be demonstrated in the routine data of a regional cancer registry. Ann Hematol 2012; 91: 561-70
  • 7 Zinzani PL, Stefoni V, Tani M, Fanti S, Musuraca G, Castellucci P. et al. Role of [18F] fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol 2009; 27: 1781-7
  • 8 Brice P, Bouabdallah R, Moreau P, Divine M, André M, Aoudjane M. et al. Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin’s disease: Analysis of 280 patients from the French registry. Société Française de Greffe de Moëlle. Bone Marrow Transplant 1997; 20: 21-6
  • 9 Moskowitz CH, Nimer SD, Zelenetz AD, Trippett T, Hedrick EE, Filippa DA. et al. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: Analysis by intent to treat and development of a prognostic model. Blood 2001; 97: 616-23
  • 10 Josting A, Franklin J, May M, Koch P, Beykirch MK, Heinz J. et al. New prognostic score based on treatment outcome of patients with relapsed Hodgkin’s lymphoma registered in the database of the German Hodgkin’s lymphoma study group. J Clin Oncol 2002; 20: 221-30
  • 11 Sureda A, Constans M, Iriondo A, Arranz R, Caballero MD, Vidal MJ. et al. Prognostic factors affecting long-term outcome after stem cell transplantation in Hodgkin’s lymphoma autografted after a first relapse. Ann Oncol 2005; 16: 625-33
  • 12 Horning SJ, Chao NJ, Negrin RS, Hoppe RT, Long GD, Hu WW. et al. High-dose therapy and autologous hematopoietic progenitor cell transplantation for recurrent or refractory Hodgkin’s disease: Analysis of the Stanford University results and prognostic indices. Blood 1997; 89: 801-13
  • 13 Jabbour E, Hosing C, Ayers G, Nunez R, Anderlini P, Pro B. et al. Pretransplant positive positron emission tomography/gallium scans predict poor outcome in patients with recurrent/refractory Hodgkin lymphoma. Cancer 2007; 109: 2481-9
  • 14 Pfreundschuh MG, Rueffer U, Lathan B, Schmitz N, Brosteanu O, Hasenclever D. et al. Dexa-BEAM in patients with Hodgkin’s disease refractory to multidrug chemotherapy regimens: A trial of the German Hodgkin’s Disease Study Group. J Clin Oncol 1994; 12: 580-6
  • 15 Colwill R, Crump M, Couture F, Danish R, Stewart AK, Sutton DM. et al. Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin’s disease before intensive therapy and autologous bone marrow transplantation. J Clin Oncol 1995; 13: 396-402
  • 16 Rodriguez J, Rodriguez MA, Fayad L, McLaughlin P, Swan F, Sarris A. et al. ASHAP: A regimen for cytoreduction of refractory or recurrent Hodgkin’s disease. Blood 1999; 93: 3632-6
  • 17 Baetz T, Belch A, Couban S, Imrie K, Yau J, Myers R. et al. Gemcitabine, dexamethasone and cisplatin is an active and non-toxic chemotherapy regimen in relapsed or refractory Hodgkin’s disease: A phase II study by the National Cancer Institute of Canada Clinical Trials Group. Ann Oncol 2003; 14: 1762-7
  • 18 Chau I, Harries M, Cunningham D, Hill M, Ross PJ, Archer CD. et al. Gemcitabine, cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply relapsed Hodgkin’s and non-Hodgkin’s lymphoma. Br J Haematol 2003; 120: 970-7
  • 19 Fermé C, Mounier N, Diviné M, Brice P, Stamatoullas A, Reman O. et al. Intensive salvage therapy with high-dose chemotherapy for patients with advanced Hodgkin’s disease in relapse or failure after initial chemotherapy: Results of the Groupe d’Etudes des Lymphomes de l’Adulte H89 Trial. J Clin Oncol 2002; 20: 467-75
  • 20 Hertzberg MS, Crombie C, Benson W, Taper J, Gottlieb D, Bradstock KF. Outpatient-based ifosfamide, carboplatin and etoposide (ICE) chemotherapy in transplant-eligible patients with non-Hodgkin’s lymphoma and Hodgkin’s disease. Ann Oncol 2003; 14 (01) Suppl i11-6
  • 21 Josting A, Rudolph C, Reiser M, Mapara M, Sieber M, Kirchner HH. et al. Time-intensified dexamethasone/cisplatin/cytarabine: An effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin’s disease. Ann Oncol 2002; 13: 1628-35
  • 22 Aparicio J, Segura A, Garcerá S, Oltra A, Santaballa A, Yuste A. et al. ESHAP is an active regimen for relapsing Hodgkin’s disease. Ann Oncol 1999; 10: 593-5
  • 23 Bartlett NL, Niedzwiecki D, Johnson JL, Friedberg JW, Johnson KB, van Besien K. et al. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin’s lymphoma: CALGB 59804. Ann Oncol 2007; 18: 1071-9
  • 24 Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT. et al. Randomized comparison of gemcitabine, dexamethasone, and cisplatin versus dexamethasone, cytarabine, and cisplatin chemotherapy before autologous stem-cell transplantation for relapsed and refractory aggressive lymphomas: NCIC-CTG LY.12. J Clin Oncol 2014; 32: 3490-6
  • 25 Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M. et al. Ifosfamide, gemcitabine, and vinorelbine: A new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica 2007; 92: 35-41
  • 26 Dreger P, Klöss M, Petersen B, Haferlach T, Löffler H, Loeffler M. et al. Autologous progenitor cell transplantation: Prior exposure to stem cell-toxic drugs determines yield and engraftment of peripheral blood progenitor cell but not of bone marrow grafts. Blood 1995; 86: 3970-8
  • 27 Weaver CH, Zhen B, Buckner CD. Treatment of patients with malignant lymphoma with Mini-BEAM reduces the yield of CD34+ peripheral blood stem cells. Bone Marrow Transplant 1998; 21: 1169-70
  • 28 Abali H, Urün Y, Oksüzoğlu B, Budakoğlu B, Yildirim N, Güler T. et al. Comparison of ICE (ifosfamide-carboplatin-etoposide) versus DHAP (cytosine arabinoside-cisplatin-dexamethasone) as salvage chemotherapy in patients with relapsed or refractory lymphoma. Cancer Invest 2008; 26: 401-6
  • 29 Chen R, Palmer JM, Martin P, Tsai N, Kim Y, Chen BT. et al. Results of a multicenter phase II trial of brentuximab vedotin as second-line therapy before autologous transplantation in relapsed/refractory Hodgkin lymphoma. Biol Blood Marrow Transplant 2015; 21: 2136-40
  • 30 Chen R, Palmer J, Martin P, Armenian S, Tsai N, Mott M. et al. Post transplant outcomes in a multicenter phase II study of brentuximab vedotin as first line salvage therapy in relapsed or refractory Hodgkin lymphoma prior to autologous stem cell transplantation. Haematologica 2016; 101: 47-8
  • 31 Moskowitz AJ, Schöder H, Yahalom J, McCall SJ, Fox SY, Gerecitano J. et al. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin’s lymphoma: A non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol 2015; 16: 284-92
  • 32 Garcia-Sanz R, Sureda A, de la Cruz F, Canales M, Gonzalez AP, Pinana JL. et al. Brentuximab vedotin and ESHAP is highly effective as second-line therapy for Hodgkin lymphoma patients (long-term results of a trial by the Spanish GELTAMO Group). Ann Oncol 2019; 30: 612-20
  • 33 Cassaday RD, Fromm J, Cowan AJ, Libby EN, Philip M, Behnia S. et al. Safety and activity of brentuximab vedotin (BV) plus ifosfamide, carboplatin, and etoposide (ICE) for relapsed/refractory (Rel/Ref) classical hodgkin lymphoma (cHL): Initial results of a phase I/II study. Blood 2016; 128: 1834-44
  • 34 Hazendonk H, Fijnvandraat K, Lock J, Driessens M, van der Meer F, Meijer K. et al. A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients. Haematologica 2016; 101: 1159-69
  • 35 LaCasce AS, Bociek RG, Sawas A, Caimi P, Agura E, Matous J. et al. Brentuximab vedotin plus bendamustine: A highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma. Blood 2018; 132: 40-8
  • 36 Herrera A, Bartlett NL, Ramchandren R, Vose JM, Moskowitz A, Feldman TA. et al. Preliminary results from a phase 1/2 study of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory Hodgkin lymphoma. Blood 2016; 128: 1105
  • 37 Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M. et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: A randomised trial. Lancet 2002; 359: 2065-71
  • 38 Younes A, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ. et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin’s lymphoma. J Clin Oncol 2012; 30: 2183-9
  • 39 Chen R, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ. et al. Five-year survival and durability results of brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma. Blood 2016; 128: 1562-6
  • 40 Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE. et al. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol 2014; 7: 24
  • 41 Ansell SM, Lesokhin AM, Borrello I, Halwani A, Scott EC, Gutierrez M. et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma. N Engl J Med 2015; 372: 311-9
  • 42 Younes A, Santoro A, Shipp M, Zinzani PL, Timmerman JM, Ansell S. et al. Nivolumab for classical Hodgkin’s lymphoma after failure of both autologous stem-cell transplantation and brentuximab vedotin: A multicentre, multicohort, single-arm phase 2 trial. Lancet Oncol 2016; 17: 1283-94
  • 43 Armand P, Shipp MA, Ribrag V, Michot JM, Zinzani PL, Kuruvilla J. et al. Programmed Death-1 blockade with pembrolizumab in patients with classical Hodgkin lymphoma after brentuximab vedotin failure. J Clin Oncol 2016; 34: 3733-9
  • 44 Diefenbach CS, Hong F, David KA. et al. A phase I study with an expansion cohort of the combination of ipilimumab and nivolumab and brentuximab vedotin in patients with relapsed/refractory Hodgkin lymphoma: A trial of the ECOG-ACRIN Cancer Research Group (E4412 Arms D and E). Blood 2016; 128: 1106
  • 45 Fehniger TA, Larson S, Trinkaus K, Siegel MJ, Cashen AF, Blum KA. et al. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood 2011; 118: 5119-25
  • 46 Younes A, Sureda A, Ben-Yehuda D, Zinzani PL, Ong TC, Prince HM. et al. Panobinostat in patients with relapsed/refractory Hodgkin’s lymphoma after autologous stem-cell transplantation: Results of a phase II study. J Clin Oncol 2012; 30: 2197-203
  • 47 Johnston PB, Inwards DJ, Colgan JP, Laplant BR, Kabat BF, Habermann TM. et al. A phase II trial of the oral mTOR inhibitor everolimus in relapsed Hodgkin lymphoma. Am J Hematol 2010; 85: 320-4