Brentuximab Vedotin Plus Bendamustine: As Salvage Regimen for Relapsed or Refractory Hodgkin Lymphoma, King Abdulaziz Medical City - Jeddah - KSA Experience

INTRODUCTION:In advanced stage Hodgkin's Lymphoma (HL), 30% of patients experience recurrence post upfront ABVD ¹.Patients with sensitive disease to salvage chemotherapy typically proceed to ASCT with curative intent ². Achievement of CR is one of the strongest predictor of favorable outcome after ASCT^3-4. Recently brentuximab vedotin plus bendamustine (BvB) became an attractive option for relapsed/refractory HL with promising efficacy and non-overlapping toxicity profiles ^5-6.

CONTEXT: No PubMed searchable articles regarding use of BvB in relapsed/refractory Hodgkin lymphoma in Saudi Arabia could be found.

OBJECTIVE:To determine overall response rate( ORR ) , PFS and OS. Secondary objective was to determine if there was a better response rate when BvB was used as a first salvage.

DESIGN:Retrospective cohort analysis.

PATIENTS:Patients with relapse /refractory hodgkin lymphoma received BvB as salvage between year 2016 and 2018 were included. Chemotherapy software and medical records were reviewed for clinical data. Twenty four patients were identified. One patient was excluded due to incomplete medical information. Patients were divided into two groups based on their indication for salvage therapy either refractory or relapse, and another two groups based on whether they received BvB as a first salvage or subsequent salvage. Brentuximab vedotin dose was 1.8 mg /kg on day 1 and bendamustine dose was 90 mg/m² on day 1,2 every 21 days.

RESULTS: Twenty-three patients (13 primary refractory and 10 relapsed) were included in this analysis. Median age at diagnosis was 28 years. After a median of 3 cycles of combination therapy BvB, the ORR was 82.6%. Ten patients (43%) achieved CR and 9 patients (39%) achieved PR. Patients who received BvB as a first salvage (65%) achieved 86.7% overall response , while ORR was 75% when BvB was given as subsequent salvage with border line P- value. After a median of 11 months follow-up, the estimated 1-year progression-free survival was 83% and 90% OS. Two patients (8.6%) experienced infusion-related reactions during second cycle.

CONCLUSIONS:BvB represents a very effective regimen for high risk relapsed or refractory HL patients; in achieving higher CR rates when used as a first salvage, with manageable toxicity profile.

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