Among patients with early-stage, favorable Hodgkin lymphoma (ES-HL), relapse is most common more than 12 months after initial diagnosis. For this reason, treatment regimens with conventional chemotherapy may be effective in a subset of patients after relapse, according to study results published in the Journal of Clinical Oncology.
Most patients with ES-HL have a good prognosis, with risk-adapted frontline treatments yielding a high rate of response. However, there is limited understanding of the characteristics of patients that relapse with contemporary treatments, as well as the period at which relapse is the most likely.
In addition, optimal treatment at relapse, whether a standard chemotherapy regimen such as bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) or high-dose chemotherapy followed by autologous stem cell transplantation (ASCT), has not yet been established.
For this study, researchers evaluated data from the German Hodgkin Study Group trials, HD10 (ClinicalTrials.gov Identifier: NCT00265018) and HD13 (ISRCTN registry Identifier: ISRCTN63474366), to determine characteristics at relapse, as well as treatment patterns and survival outcomes thereafter, among patients with ES-HL who had reached complete remission.
Among more than 2500 patients who partook in HD10 and HD13, the researchers identified 174 patients who reached complete remission and subsequently experienced relapse. Relapse mostly occurred more than 12 months after initial diagnosis and among those with stage I to II disease.
A total of 85 patients (49%) who experienced a relapse received a conventional chemotherapy regimen, 68% of which were BEACOPP regimens; 70 patients (41%) received ASCT, 11 patients (6%) received radiotherapy, and 4 patients (2%) received palliative regimens.
At relapse, patients older than 60 years had a hazard ratio for shorter second progression-free survival (PFS) of 3 (P =.0029). Conventional chemotherapy regimens did not lead to a shorter second PFS period vs ASCT (hazard ratio, 0.7; P =.39).
The 2-year PFS and OS rates noted with post-relapse conventional chemotherapy were 94% and 97.2%, respectively.
“Taken together, we provide a comprehensive analysis of disease and treatment characteristics for relapse after initial remission with contemporary, first-line [combined-modality treatment] of ES-HL,” the authors wrote.
The authors also noted that conventional chemotherapy “may constitute a reasonable therapeutic option and potential alternative to ASCT in selected patients with relapse after initial treatment of ES-HL, especially in case of contraindications to ASCT or a resource-constrained setting precluding such intensified approaches.”
Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Bröckelmann PJ, Müller H, Guhl T, et al. Relapse after early-stage, favorable Hodgkin lymphoma: disease characteristics and outcomes with conventional or high-dose chemotherapy. J Clin Oncol. Published online October 15, 2020. doi:10.1200/JCO.20.00947