What second-line regimen should we use for recurrent

Hodgkin lymphoma prior to stem cell transplant? 

Pankaj Malhotra, MDPGI, Chandigarh, India

Outline of talk

• Why auto is better than continuing chemo in relapsed HL?• Results of auto transplant in relapsed HL• Predictors of transplant outcome• Chemotherapy regimens used before transplant• Does any specific chemotherapy regimen make diff in outcome?• Upcoming therapies

Results of randomized trials

Chemotherapy vs Autologous SCT in relapsed HL

ABMTR data and multicentric studies data on autologous SCT in relapsed HL

Summary

• Autologous stem cell transplantation improves EFS and PFS in relapsed HL

Factors predicting poor outcome• B symptoms• Stage IV disease at relapse• Residual disease at the time of transplantation• More than three prior chemotherapies (chemo-resistant disease)

Further predictors of outcome

Regimens used before transplant

Best salvage regimen

• Effective/High response rates• Out patient administration• Minimal effect on stem cell mobilisation• Minimal toxicity

60-88% 17-56% 0-9%

69-89% 17-60%

Upcoming therapies

Conclusions

• ORR of salvage chemotherapy regimens in relapsed refractory HL vary from 60-80%• CR rates vary from 20-40%• Brentuximab as a single agent is able to achieve ORR and CR rates

similar to chemotherapy regimens• The available data is thus compelling enough to recommend use of

Brentuximab in relapsed refractory HL before auto or allogeneic stem cell transplantation