A targeted salvage therapy with Brentuximab vedotin in heavily treated refractory or relapsed pediatric Hodgkin lymphoma patients before and after stem cell transplantation

Hodgkin’s lymphoma (HL) is highly curable disease in its early stages, butin advanced stages, it presents a dilemma when it becomes refractory orrelapses after several rounds of chemotherapy. Brentuximab vedotin (BV) isan antibody–drug conjugate that targets the tumor necrosis receptor familyprotein member CD30 positive malignancies via an anti-CD30 monoclonalantibody linked to monomethyl auristatin-E. In adult and pediatric studies, ithas been shown to be an effective salvage therapy for primary refractory HLor relapse after autologous stem cell transplant (ASCT).Between July 2012 and August 2017, we administered BV (1.8 mg/m2 everythree weeks; 12 cycles totally) with doxorubucin, vinblastin, dacarbazine(AVD), rituximab + ifosfamide + carboplatin + etoposide (RICE), orbendamustine combination treatment in pediatric HL patients, who werepreviosuly treated for refractory or relapsed advanced stage HL before (sevenpatients) or after (one patient) ASCT in our center. After eight BV courses, onepatient was able to undergo match unrelated donor (MUD) SCT. Another sevenpediatric HL patients, who were not able to go into remission with any otherclassical HL chemotherapy protocols, received 4–6 courses of BV-AVD and/orRICE/bendamustine. All were able to undergo ASCT after negative positronemission tomography (PET) imaging results. After ASCT, we switched to BVas consolidation therapy until a total of 12 cycles was completed. Patientswent into remission after a median 34 (range: 12–42) months from the startof BV treatment. BV is an encouraging, well- tolerated, and effective targetedtherapy especially when combined with AVD or when alternated with anothertargeted therapy combination, including RICE, when needed.

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