Brentuximab Vedotin Combined With Chemotherapy in Patients With Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma

Anita Kumar, Carla Casulo, Ranjana H. Advani, Elizabeth Budde, Paul M. Barr, Connie L. Batlevi, Philip Caron, Louis S. Constine, Savita V. Dandapani, Esther Drill, Pamela Drullinsky, Jonathan W. Friedberg, Clare Grieve, Audrey Hamilton, Paul A. Hamlin, Richard T. Hoppe, Steven M. Horwitz, Ashlee Joseph, Niloufer Khan, Leana LaraqueMatthew J. Matasar, Alison J. Moskowitz, Ariela Noy, Maria Lia Palomba, Heiko Schöder, David J. Straus, Shreya Vemuri, Joanna Yang, Anas Younes, Andrew D. Zelenetz, Joachim Yahalom, Craig H. Moskowitz

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

PURPOSE: To improve curability and limit long-term adverse effects for newly diagnosed early-stage (ES), unfavorable-risk Hodgkin lymphoma. METHODS: In this multicenter study with four sequential cohorts, patients received four cycles of brentuximab vedotin (BV) and doxorubicin, vinblastine, and dacarbazine (AVD). If positron emission tomography (PET)-4-negative, patients received 30-Gy involved-site radiotherapy in cohort 1, 20-Gy involved-site radiotherapy in cohort 2, 30-Gy consolidation-volume radiotherapy in cohort 3, and no radiotherapy in cohort 4. Eligible patients had ES, unfavorable-risk disease. Bulk disease defined by Memorial Sloan Kettering criteria (> 7 cm in maximal transverse or coronal diameter on computed tomography) was not required for cohorts 1 and 2 but was for cohorts 3 and 4. The primary end point was to evaluate safety for cohort 1 and to evaluate complete response rate by PET for cohorts 2-4. RESULTS: Of the 117 patients enrolled, 116 completed chemotherapy, with the median age of 32 years: 50% men, 98% stage II, 86% Memorial Sloan Kettering-defined disease bulk, 27% traditional bulk (> 10 cm), 52% elevated erythrocyte sedimentation rate, 21% extranodal involvement, and 56% > 2 involved lymph node sites. The complete response rate in cohorts 1-4 was 93%, 100%, 93%, and 97%, respectively. With median follow-up of 3.8 years (5.9, 4.5, 2.5, and 2.2 years for cohorts 1-4), the overall 2-year progression-free and overall survival were 94% and 99%, respectively. In cohorts 1-4, the 2-year progression-free survival was 93%, 97%, 90%, and 97%, respectively. Adverse events included neutropenia (44%), febrile neutropenia (8%), and peripheral neuropathy (54%), which was largely reversible. CONCLUSION: BV + AVD × four cycles is a highly active and well-tolerated treatment program for ES, unfavorable-risk Hodgkin lymphoma, including bulky disease. The efficacy of BV + AVD supports the safe reduction or elimination of consolidative radiation among PET-4-negative patients.

Original languageEnglish
Pages (from-to)2257-2265
Number of pages9
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume39
Issue number20
DOIs
StatePublished - Jul 10 2021

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