The experience of using the Brentuximab vedotin in the treatment of children and young adults with primary refractory course and relapses of Hodgkin's lymphoma

Abstract

In many international studies, brentuximab vedotin (BV) has been shown to be highly effective in adult patients with primary refractory forms or recurrent Hodgkin’s lymphoma (HL). The group of children and adolescents received BV is not sufficient yet to assess the effectiveness and toxicity as in adults. In multicenter randomized trials BV was shown to be highly effective in adult patients. Aims: to evaluate the effectiveness and toxicity of anti-relapse therapy with BV followed by hematopoietic stem cell transplantation in children, adolescents and young adults with primary refractory forms of Hodgkin's Lymphoma (HL) and in patients with relapses of the disease. This study was approved by the Independent Ethical Committee and the Academic Council of Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation. In the 2012–2019 period 54 patients with primary refractory course and relapses of LH (Hodgkin's Lymphoma) were enrolled, among them 24 (44.4%) boys and 30 (55.6%) girls aged 4 to 25 years at the time of diagnosis of HL (average age-13.84.4 years). Therapy included BV as a part of block BB (brentuximab vedotin, ribomustin, dexamethasone) (n = 44) and BV monotherapy (n = 12). Complete response was achieved for 44 (81.4%) patients (pts) received BV (as a part of block BB - 37 pts and as monotherapy – 7 pts). Seven (12.9%) among 54 patients were transferred to therapy with PDL1 inhibitors (nivolumab, pembrolizumab) due to progression/refractoriness. Three (5.7%) patients were lost from observation. In our study, toxicity was observed in 7.4% of patients (n = 4) received brentuximab as a part of block BB: grade 4 hematological toxicity (n = 3) and infectious complications in the form of mucositis (n = 1). There was no evidence of any toxicity among pts received BV as monotherapy. BV in children, adolescents and young adults with primary refractory course and relapses of LH had shown high efficiency, which was not accompanied by significant toxicity.