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Bone Marrow Failure
Combining brentuximab vedotin with dexamethasone, high-dose cytarabine and cisplatin as salvage treatment in relapsed or refractory Hodgkin lymphoma: the phase II HOVON/LLPC Transplant BRaVE study
Ferrata Storti Foundation
Haematologica 2021 Volume 106(4):1129-1137
Marie José Kersten,1,2* Julia Driessen,1* Josée M. Zijlstra,2,3
Wouter J. Plattel,2,4 Franck Morschhauser,5 Pieternella J. Lugtenburg,2,6 Pauline Brice,7 Martin Hutchings,8 Thomas Gastinne,9 Roberto Liu,1
Coreline N. Burggraaff,3 Marcel Nijland,2,4 Sanne H. Tonino,1,2
Anne I.J. Arens,10 Roelf Valkema,11 Harm van Tinteren,12 Marta Lopez-Yurda,12 Arjan Diepstra,2,13 Daphne De Jong2,14 and Anton Hagenbeek1,2
1Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, the Netherlands; 2HOVON and Lunenburg Lymphoma Phase I/II Consortium (LLPC), the Netherlands; 3Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; 4Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Department of Hematology, Centre Hospitalier Universitaire, Lille, 6Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; 7Department of Hematology, Hopital Saint Louis, Paris, France; 8Department of Hematology, Rigshospitalet, Copenhagen, Denmark; 9Department of Hematology, Centre Hospitalier Universitaire, Nantes, France; 10Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; 11Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; 12Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands; 13Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands and 14Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands; HOVON Pathology Facility and Biobank, Amsterdam, the Netherlands
*MJK and JD contributed equally as co-first authors.
ABSTRACT
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 bren- tuximab vedotin (BV) to DHAP (dexamethasone, high-dose cytarabine, cis- platin) to improve the mCR rate. In a phase I dose-escalation part of the study in 12 patients, we showed that BV-DHAP is feasible. This phase II study included 55 R/R cHL patients (23 primary refractory). Treatment con- sisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexam- ethasone 40 mg days 1-4, cisplatin 100 mg/m2 day 1 and cytarabine 2x2 g/m2 day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central [18F]fluorodeoxyglucose (FDG) - positron emission tomography (PET) - computed tomography (CT) scan 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 (3 were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. Two-year PFS was 74% [95%CI: 63-86] and overall survival 95% [95%CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematologic toxicity, fever, nephrotoxicity, ototoxici- ty (grade 1/2), and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2); 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).
Correspondence:
MARIE JOSÉ KERSTEN
m.j.kersten@amsterdamumc.nl
Received: November 18, 2019. Accepted: March 19, 2020. Pre-published: April 9, 2020.
https://doi.org/10.3324/haematol.2019.243238
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