Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspecti
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Improving outcomes after autologous transplantation in relapsed/refractory Hodgkin lymphoma: a European expert perspective Anna Sureda1,2*, Marc André3, Peter Borchmann4, Maria G. da Silva5, Christian Gisselbrecht6, Theodoros P. Vassilakopoulos7, Pier Luigi Zinzani8,9 and Jan Walewski10
Abstract: Autologous stem cell transplantation (ASCT) is a well-established approach to treatment of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL) recommended by both the European Society for Medical Oncology and the National Comprehensive Cancer Network based on the results from randomized controlled studies. However, a considerable number of patients who receive ASCT will progress/relapse and display suboptimal post-transplant outcomes. Over recent years, a number of different strategies have been assessed to improve post-ASCT outcomes and augment HL cure rates. These include use of pre- and post-ASCT salvage therapies and post-ASCT consolidative therapy, with the greatest benefits demonstrated by targeted therapies, such as brentuximab vedotin. However, adoption of these new approaches has been inconsistent across different centers and regions. In this article, we provide a European perspective on the available treatment options and likely future developments in the salvage and consolidation settings, with the aim to improve management of patients with HL who have a high risk of post-ASCT failure. Conclusions: We conclude that early intervention with post-ASCT consolidation improves outcomes in patients with R/R HL who require ASCT. Future approvals of targeted agents are expected to further improve outcomes and provide additional treatment options in the coming age of personalized medicine. Keywords: Consolidation, HL, Salvage, Stem cell transplantation
Background Hodgkin lymphoma (HL) is considered to be a curable hematological malignancy. The currently available chemotherapies and targeted therapies deliver frontline cure rates of approximately 90% for patients with early- or intermediatestage disease and 70–90% for patients with advanced-stage disease [1–7]. For patients who either relapse or are refractory * Correspondence: [email protected] 1 Hematology Department, Hematopoietic Stem Cell Transplant Programme, Institut Català d’Oncologia-Hospital Duran i Reynals, Gran Via de l’Hospitalet, 199 – 203, 08908 Barcelona, Spain 2 Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona (UB), Barcelona, Spain Full list of author information is available at the end of the article
to frontline treatment, the standard of care comprises salvage chemotherapy followed by autologous stem cell transplantation (ASCT) [8–11]. Despite this intensified approach, up to 50% of patients will experience progressive disease following ASCT [9, 12, 13], representing a population with high-risk disease. This led to initiation of clinical studies in the 1990s to improve post-ASCT outcomes and consequently improve HL cure rates [14, 15], many of which showed less than satisfactory
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