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Outcomes With Second-Line Therapy After Relapse in Patients With Early-Stage, Favorable, Classical Hodgkin Lymphoma


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In an analysis of two German Hodgkin Study Group trials reported in the Journal of Clinical Oncology, Bröckelmann et al found that second-line treatment with conventional polychemotherapy resulted in similar second progression–free survival (progression-free survival-2) durations vs high-dose chemotherapy plus autologous stem cell transplantation (HDCT-ASCT) after relapse in patients with early-stage, favorable classical Hodgkin lymphoma.

Study Details

The study involved data from patients in the German Hodgkin Study Group HD10 and HD13 randomized trials in patients receiving first-line treatment for early-stage, favorable, classical Hodgkin lymphoma. In the current analysis, characteristics of relapse in patients in the trials were identified, and progression-free survival-2 was compared between patients receiving conventional polychemotherapy vs HDCT-ASCT as second-line treatment after relapse. 

“After contemporary treatment of early-stage, favorable, classical Hodgkin lymphoma, relapse mostly occurred 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after early-stage, favorable, classical Hodgkin lymphoma.”
— Bröckelmann et al

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Key Points

Among 1,370 randomly assigned patients in the HD10 trial and 1,502 randomly assigned patients in HD13, 174 evaluable patients with relapse after complete remission were identified, including 53 in HD10 and 121 in HD13. Among patients with relapse, 80% had relapse at > 12 months after diagnosis and 52% had stage I or II disease.

Among 172 relapsing patients with known second-line therapy, 85 received conventional polychemotherapy (49%), 70 received HDCT-ASCT (41%), 11 received radiotherapy only (6%), and 4 received palliative single-agent therapies (2%). Conventional polychemotherapy was predominantly BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; 68%), followed by ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine; 19%), or other regimens (13%).

Median follow-up for progression-free survival-2 among patients with relapse was 74 months for patients from the HD10 trial and 57 months for those from the HD13 trial.

Among all relapsed patients, progression-free survivial-2 was comparable with conventional polychemotherapy vs HDCT-ASCT (hazard ratio [HR] from Cox regression analysis = 0.7, 95% confidence interval [CI] = 0.3–1.6, P = .39). Overall survival was also similar for conventional polychemotherapy vs HDCT-ASCT (HR = 0.8, 95% CI = 0.3–1.9, P = .57).

Progression-free survival-2 was comparable in the HD10 trial vs the HD13 trial among patients receiving conventional polychemotherapy, but was worse with HDCT-ASCT in the older HD10 trial vs the HD13 trial. HDCT-ASCT in the HD10 trial was associated with an increase in deaths attributable to causes other than Hodgkin lymphoma vs the more recent HD13 trial (67% vs  37% of deaths).

Patients older than 60 at relapse had shorter progression-free survival-2 (HR = 3.0, P = .0029) and primarily received conventional polychemotherapy (33 of 49; 67%) rather than HDCT-ASCT (n = 8; 16%).

In analysis adjusting for age and treatment with HDCT-ASCT in HD10, no significant difference in progression-free survival-2 was observed between conventional polychemotherapy vs HDCT-ASCT (HR = 0.7, P = .39).

A sensitivity analysis among patients age 60 or younger from the HD13 trial showed 2-year progression-free survival rates of 94.0% with conventional polychemotherapy vs 83.3% with HDCT-ASCT, and 2-year overall survival rates of 97.2% vs 88.4%.

The investigators concluded, “After contemporary treatment of early-stage, favorable, classical Hodgkin lymphoma, relapse mostly occurred 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after early-stage, favorable, classical Hodgkin lymphoma.”

Paul Bröckelmann, MD, of the University Hospital of Cologne, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The German Hodgkin Study Group and the HD10 and HD13 trials were supported by grants from the German Cancer Aid. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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