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  • Combining brentuximab vedot...
    Kersten, Marie José; Driessen, Julia; Zijlstra, Josée M; Plattel, Wouter J; Morschhauser, Franck; Lugtenburg, Pieternella J; Brice, Pauline; Hutchings, Martin; Gastinne, Thomas; Liu, Roberto; Burggraaff, Coreline N; Nijland, Marcel; Tonino, Sanne H; Arens, Anne I J; Valkema, Roelf; van Tinteren, Harm; Lopez-Yurda, Marta; Diepstra, Arjan; De Jong, Daphne; Hagenbeek, Anton

    Haematologica (Roma), 04/2021, Letnik: 106, Številka: 4
    Journal Article

    Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplant (auto-PBSCT) predicts progression free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP to improve the mCR rate. In a Phase I dose-escalation part in 12 patients, we showed that BV-DHAP is feasible. This Phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40mg days 1-4, cisplatin 100mg/m2; day 1 and cytarabine 2x2g/m2; day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central FDG-PET-CT review, 42 of 52 evaluable patients (81% 95% CI: 67-90) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (three were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. The 2-year PFS was 74% 95% CI: 63-86, and the overall survival 95% 95% CI: 90-100. Toxicity was manageable and mainly consisted of grade 3/4 hematological toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2) and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2) and all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. ClinicalTrials.gov identifier: NCT02280993.