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This phase I/II study assessed the combination of brentuximab vedotin (BV) with ifosfamide-carboplatin-etoposide (ICE) as a second-line therapy in refractory/relapsed (R/R) classical Hodgkin lymphoma (cHL) patients. Phase I study was designed to determine the maximum tolerated dose (MTD) of BV (10 patients) and phase II evaluated the rate of complete metabolic response (CMR) after 2 cycles of BV-ICE (42 patients). There were no dose-limiting toxicities (DLT) during phase I recommending BV 1.8 mg/kg for phase II. Twenty-six patients (61.9%) achieved CMR after 2 cycles of BV-ICE and 37 patients (88%) were transplanted. With a median follow-up of 38 months, the 3-year progression free survival (PFS) and overall survival (OS) rate were 64.3% and 100%, respectively. Hematological toxicities (81%) and infections (21%) were the most frequent adverse event encountered BV-ICE regimen is feasible with manageable toxicities and could be an alternative to other salvage treatments. Trial Registration: ClinicalTrials.gov identifier: NCT02686346 [ABSTRACT FROM AUTHOR]

Patients with classical Hodgkin lymphoma (cHL) typically receive first-line chemotherapy or chemoradiotherapy, and cure rates are high [[1]]. When response was evaluated by prior lines of therapy, ORR was 79.4% (95% CI, 67.3-88.5) among patients who had received at least three prior therapies ( I n i = 63) and 100.0% (95% CI, 63.1-100.0) among patients who had received fewer than three prior therapies ( I n i = 8). However, for patients who have primary refractory cHL that does not respond to salvage chemotherapy or for patients who are ineligible for transplantation because of comorbidity, pembrolizumab could be an effective treatment option. [Extracted from the article]

In KEYNOTE-087, pembrolizumab had a 69% overall response rate and acceptable safety in patients with relapsed/refractory classical Hodgkin lymphoma (rrHL). We assessed health-related quality of life (HRQoL) in KEYNOTE-087. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the EuroQoL Five Dimensions Questionnaire 3-level version (EQ-5D) were administered to 206 patients across three cohorts defined by lymphoma progression after: (1) autologous stem cell transplantation (ASCT) and subsequent brentuximab vedotin (BV) (n = 69); (2) salvage chemotherapy and BV (n = 79); and (3) ASCT without post-transplantation BV (n = 58). Compliance/completion rates were ≥90% at week 12 and ≥70% at week 24. QLQ-C30 global health status/QoL and EQ-5D visual analog scale scores showed mean increases from baseline in overall health at all assessed timepoints. With few exceptions, mean improvements from baseline to weeks 12 and 24 in QLQ-C30 functional and symptom scores occurred in all cohorts. Clinicaltrials.gov identifier: NCT02453594. [ABSTRACT FROM AUTHOR]

Brentuximab vedotin (BV) is an antibody-drug conjugate (ADC) composed of a CD30-directed monoclonal antibody covalently linked to the anti-microtubule agent monomethyl auristatin E (MMAE). These patients were more often ALK- (55%) than in the BV cohort (20% of ALCL patients). We did not observe any difference in survival outcomes between patients treated with or without pre-transplant BV, probably due to the relatively short follow-up period for BV-treated patients and the small cohort sizes overall. In a recent retrospective study of 240 patients treated in a French Named Patient Program, the median PFS of patients who received transplantation after BV was significantly better than those who did not (18.8 vs. 8.7 months). [Extracted from the article]

The article focuses on a study regarding management of relapsed or refractory follicular lymphoma (FL)patients in daily practice. It mentions that Relapsed or refractory follicular lymphoma (R/R FL) is highly sensitive to both radiotherapy and chemotherapy. It presents information on immunochemotherapy. It also mentions that commonly reported drug-related adverse reactions for maintenance therapy were infusion-associated symptoms, neutropenia, and infections.

A letter to the editor is presented in response to the article "Consolidation therapy with mitoxantrone, ifosfamide and etoposide with or without rituximab before stem cell transplantation in relapsed diffuse large B-cell lymphoma patients failing second-line treatment" in the previous issue.

The article focuses on the immune checkpoint inhibitor (ICI) named Pembrolizumab for adults with refractory classical Hodgkin lymphoma (HL). It discusses the initial therapies with mechlorethamine, vincristine, procarbazine and prednisone (MOPP) and doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD).

Initial spinal cord compression (ISCC) in B-cell non-Hodgkin lymphoma (NHL) is rarely present at diagnosis. We performed a multicenter retrospective analysis of 66 patients with ISCC, including diffuse large B-cell (DLBCL) (70%), follicular (20%), small lymphocytic (6%), marginal zone (2%) and B-cell unclassified (2%) lymphomas, with the aim of describing their management and outcomes, as well as the occurrence of central nervous system (CNS) relapses. All but two patients received cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or CHOP-like regimens, with rituximab in 61% of cases. Forty-six patients received CNS prophylaxis. The 5-year overall survival and progression-free survival were 78% and 65% for DLBCL, and 60% and 48% for indolent lymphomas, respectively. CNS relapses occurred in four (6%) patients, all with DLBCL and all in the cerebellum. Initial decompressive procedures, intradural involvement, cerebrospinal fluid infiltration and lack of CNS prophylaxis did not influence survival. Adverse prognostic factors were male sex, poor performance status, elevated lactate dehydrogenase and high age-adjusted international prognostic index. [ABSTRACT FROM AUTHOR]

Splenectomy is considered as one of the first-line treatments for symptomatic patients with splenic marginal zone lymphoma (SMZL). Between 1997 and 2012, 100 hepatitis C virus-negative patients with SMZL were treated by splenectomy as first-line treatment. At 6 months, all patients but three recovered from all cytopenias. The median lymphocyte count at 6 months and 1 year was 11.51 × 109/L and 6.9 × 109/L, respectively. Median progression-free survival (PFS) was 8.25 years. The 5-year and 10-year overall survival (OS) rates were 84% and 67%, respectively. Histological transformation occurred in 11% of patients, and was the only parameter significantly associated with a shorter time to progression ( p = 0.0001). Significant prognostic factors for OS were age ( p = 0.0356) and histological transformation ( p = 0.0312). In this large retrospective cohort, we confirmed that splenectomy as first-line treatment in patients with SMZL corrected cytopenias and lymphocytosis within the first year and was associated with a good PFS. [ABSTRACT FROM AUTHOR]

Limited data support the use of bendamustine in Hodgkin lymphoma (HL). This retrospective study evaluated the efficacy and toxicity of bendamustine in 28 patients with refractory HL or relapsed HL after autologous stem cell transplant (ASCT) used as part of a compassionate use program. The median number of therapies before bendamustine was 5 (3-8). ASCT and non-myeloablative allogeneic transplant were previously performed for 25 and six patients, respectively. The median number of bendamustine cycles administered was 3 (1-12). The objective response rate was 50% with complete response (CR) in 29% of patients. The median progression-free survival was 5.7 months, and 10.2 months in patients with CR. During the first six cycles, two patients had a febrile neutropenia and four patients had grade 3-4 thrombocytopenia. Bendamustine was effective in these highly pretreated patients with HL. It might be used earlier in the treatment strategy of HL and in combination with other active drugs. [ABSTRACT FROM AUTHOR]

This multicenter phase II study assessed the feasibility and efficacy of a weekly chemotherapy regimen with a moderately escalated dose of doxorubicin administered over 16 weeks, followed by radiation therapy (RT) to bulky sites. From July 1996 to February 1998, 44 untreated patients with stage IIIB-IV Hodgkin's lymphoma (HL), and 0 - 2 risk factors described by the Memorial Sloan-Kettering Cancer Center, were treated. Chemotherapy was a combination of increased-dose doxorubicin with conventional doses of cyclophosphamide, vinblastine, prednisone, vindesine, bleomycin, and etoposide. Patients received four cycles of the weekly regimen for 16 weeks. Forty-one patients received the planned four cycles of chemotherapy, and RT was delivered to 36 patients. The incidence of WHO grade 3 - 4 neutropenia was 90%. A total of 39 patients achieved a complete remission (88.6%). The median follow-up was 95 months. The 7-years freedom from treatment failure and overall survival estimates were 57% (95% confidence interval (CI), 41% - 70%), and 93% (95% CI, 80 - 98%), respectively. The relapse rate was related to the short duration of chemotherapy, and the failure to prevent relapses with consolidation RT. In this study population the 16-week regimen and RT to bulky sites were not sufficient for disease control. [ABSTRACT FROM AUTHOR]

We analyzed 33 patients with AILD T-NHL in a retrospective multicentric study. The median age was 62 yr (35-84 yr) (19 patients over 60 yr). Advanced disease (n = 31) and B-symptoms were consistently found (n = 29) and 20 patients had bone marrow involvement. The main laboratory abnormalities were: anemia (n = 13), hypereosinophilia (n = 13), lymphopenia (n = 14), hypergammaglobulinemia (n = 17), elevated lactate dehydrogenase (LDH) level (n = 24). First-line therapy was chemotherapy (ChT) alone (n = 25) or ChT after steroids (n = 8). Most patients received a CHOP-like regimen for a median number of 6 cycles and 3 patients received interferon α (IFNα) as consolidation after chemotherapy. With a median follow-up of 46 mo, 60% achieved a complete response but the outcome was poor with a relapse rate at 56%, a median survival referring to the total population was of 36 mo (2−108+mo) and an overall survival at 5 yr of 36%. Two patients received high-dose chemotherapy (with total body irradiation) and autologous progenitor-cell transplantation for chemosensitive relapse and were free of disease at, respectively, 76 and 24 mo+. In conclusion AILD T-NHL still has a poor prognosis compared to other NHL. The role of intensive therapy and IFNα still remains to be evaluated. [ABSTRACT FROM AUTHOR]