Experience with second-line therapy of relapsing and refractory Hodgkin’s lymphoma in the Irkutsk region

Summary

Introduction

Fifty new cases of Hodgkin’s lymphoma (HL) are diagnosed annually in the Irkutsk Oncology Center. Despite the successes achieved in the treatment of HL from 10 to 25% of patients have refractory or relapse. The high-dose chemotherapy (HDCT) followed by auto-SCT is the standard therapy of relapsed/refractory HL. Purpose of our study was to estimate efficacy and safety of second line therapy in patients with relapsed/refractory HL in the Irkutsk Regional Oncology Center for a 2-year period (2016-2018).

Patients and methods

The analysis of 11 case of relapsed/refractory HL have been performed, which have been treated with second line therapy in the Irkutsk Oncology Clinic from January 2016 till June 2018. The median age of the patients was 34 years (22-46). The distribution by sex: men – 6, women – 5. There was prevalence of patients with advanced stages of the disease: stage III-IV (n=8), and only in 3 patients – second stage. The average number of cycles of first line therapy was 15 (from 8 to 25 cycles). All patients received first line chemo with ABVD and BEACOPP, and 10 patients have undergone radiotherapy.

Results

At the time of second line initiation 5 patients had a relapse of HL: early (n=2), late (n=3), 6 patients had resistance to the therapy: primary (n=2), secondary (n=4). The median time from the diagnosis of HL till the SCT was 1 year (1 year – 10 years 9 months.). Conditioning regimen according to the BeEAM protocol have been used for all patients. Stem cells source was: bone marrow (n=1), peripheral blood (n=10). The mean of stem cells in graft was 7.99x106/kg. The remission re-induction chemotherapy included: DHAP (n=3), GemOx (n=4), ICE (n=3), IGEV (n=1). The effect of re-induction chemotherapy was: complete remission (n=5), partial remission (n=5), no response – 1 patient. The mortality rate at day 100 was 0%. Evaluation of the response after complete second line therapy was performed in 9 patients: complete remission was achieved in 6 patients (67%), 3 patients (33%) no response was received to the therapy, which is probably due to the lack of complete remission in front of auto-SCT (n=1) and a long time interval up to the HDCT. Overall survival was 100% with the medial follow up time – 18 months.

Conclusion

Our experience confirms the safety of the second line of therapy, including HDCT with auto-SCT for the treatment of relapsed/refractory HL, and also demonstrates that the efficacy depends on the time from the moment of diagnosis of HL to transplant and the status of the underlying disease at the moment of auto-SCT.

Keywords

Hodgkin’s lymphoma, relapse, refractoriness, high-dose chemotherapy, auto-SCT.