Abstract 52P
Background
In patients (pts) with relaped/refractory classical Hodgkin Lymphoma (R/R cHL) ineligible for stem cell transplant (SCT), contemporary therapy outcomes are under-reported and cure is uncertain. This study assessed the efficacy of contemporary agents in treating R/R cHL in SCT ineligible pts.
Methods
This was a retrospective, single centre study of R/R cHL pts ineligible for SCT per clinician assessment, treated 2010-2022 with brentuximab vedotin (BV), checkpoint inhibitors (CPI) and/or bendamustine (Benda). Response was assessed by PET per Lugano 2014.
Results
81 pts were eligible (median age 31, range 15-85, 54.3% male). 95% were aged ≤70 at diagnosis. Therapies at relapse were BV (n=74), CPI (n=42) and Benda monotherapy (n=28). Prior SCT occurred in 16, 15 and 4 pts respectively. All Benda pts underwent SCT (n=5 ASCT, n=10 alloSCT) or further therapy. 13 CPI and 13 BV pts had SCT (n=1 ASCT, n=12 alloSCT and n=6 ASCT, n=7 alloSCT respectively). Third and fourth line therapy was BV (n=46), CPI (n=27) and Benda (n=24). All were transplant ineligible based on poor response to salvage therapy (n=46, 26 and 23) or poor fitness/comorbidity (n=0, 1 and 1 respectively). Median PFS was longest for Benda (46.2 months (m), range 1.1-86.7), followed by CPI (6.2m, 0.8-35.4) and BV (4.4m, 0.4-61.2) (Table). Among prior transplanted pts, median PFS was 81.3 (6.4-86.8), 4.8 (5.1-30.8), 22.3 (5.1-30.8) months respectively. There was no difference in PFS between prior transplanted and SCT ineligible pts. Median follow-up for BV, CPI and Benda was 43.2m, 28m and 34.4m respectively. 4.1% of BV and 14.3% of CPI pts remain progression free without consolidation or further therapy. Table: 52P
Treatment outcomes
| BV (n=74) | CPI (n=42) | Benda (n=28) | |||||
| N | 2L | 11 | 0 | 0 | |||
| 3L | 58 | 7 | 1 | ||||
| 4L | 4 | 25 | 18 | ||||
| 5L | 1 | 10 | 9 | ||||
| Median number of cycles (range) | 4 (1-14) | 8 (1-50) | 3 (1-6) | ||||
| ORR | All pts | 34/74 (46%) | 19/42 (45.2%) | 21/28 (75%) | |||
| Transplant ineligible | 27/58 (46.6%) | 8/27 (29.6%) | 17/24 (70.8%) | ||||
| Previously transplanted | 7/16 (43.8%) | (11/15) 73.3% | 4/4 (100%) | ||||
| CR | All pts | 18/74 (24.3%) | 14/4 (33.3%) | 11/28 (39.3%) | |||
| Transplant ineligible | 15/58 (25.9%) | 5/27 (18.6%) | 10/24 (41.7%) | ||||
| Previously transplanted | 3/16 (18.8%) | 9/15 (60%) | 1/4 (25%) | ||||
| Median PFS (all lines) (months) | All pts | CR | | CR | CR | | ||
| 37.4 | 3.1 | UD | 5.7 | UD | 6.4 | ||
| Transplant ineligible | 61.2 | 2.9 | UD | 5.5 | UD | 6.2 | |
| Prior transplant | 19.5 | 3.9 | UD | 10.6 | 81.3 | 46.6 | |
Conclusions
In this retrospective study of pts with R/R cHL, we show that a small number may achieve durable disease control without transplant consolidation, especially after CPI therapy. Further research is needed to identify factors predicting this outcome.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The Christie NHS Foundation Trust.
Funding
Has not received any funding.
Disclosure
B. Phillips: Financial Interests, Personal, Research Grant: Honoraria; Financial Interests, Personal, Other, Travel Expenses: Takeda. K. Linton: Financial Interests, Personal, Other, Research Support, Consultant, Speaker's Bureau and Scientific Advisory Board: AbbVie / Genmab; Financial Interests, Personal, Advisory Board, Including research support: Roche, Beigene; Financial Interests, Personal, Speaker’s Bureau: Nurix; Financial Interests, Personal, Advisory Board: BMS. All other authors have declared no conflicts of interest.