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Lymphoma The Use of Brentuximab Vedotin with or without Subsequent Allogeneic Stem Cell Transplantation in Selected Patient Groups Ulrich Jager, 1 Felix Keil 2 and Martin Hutchings 3 1. Professor of Hematology, Medical University of Vienna, Vienna, Austria; Head of the Clinical Department of Hematology and Hemostasis, Vienna General Hospital, Vienna, Austria; 2. Professor of Hematology, Hanusch Hospital, Vienna, Austria; 3. Clinical Oncologist, Department of Hematology, Rigshospitalet, Copenhagen, Denmark Abstract While combined chemotherapy regimens can be effective in classical Hodgkin’s lymphoma (cHL) and systemic anaplastic large cell lymphoma (sALCL), around a third of patients are unresponsive or relapse within a few years of treatment. Allogeneic stem cell transplantation (allo- SCT) may achieve long-term disease control in patients with chemoresistant disease, but many patients are unable to undergo allo-SCT. Brentuximab vedotin (BV) is a novel antibody-drug conjugate targeting CD30. Recent data have suggested that this treatment may be beneficial in patients who have had an unsatisfactory response to at least two prior treatments and are not eligible for allo-SCT. In addition, BV may be used to reduce tumour burden, allowing patients to subsequently progress to allo-SCT. This article discusses case studies of treatment-refractory patients with cHL and sALCL, for whom BV has provided durable complete responses (CRs). Keywords Classical Hodgkin’s lymphoma (cHL), systemic anaplastic large cell lymphoma (sALCL), brentuximab vedotin Disclosure: Ulrich Jager has received honoraria and participated in Advisory Boards for Takeda. Felix Keil has nothing to disclose is relation to this article. Martin Hutchings has participated in Advisory Boards for Takeda, Celgene, Genentech and Janssen, and has been a consultant to Takeda and Genentech. Acknowledgements: Medical writing assistance was provided by Katrina Mountfort at Touch Medical Media and funded by Takeda. Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions. Informed consent was received from the patients involved in these case studies. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 25 May 2015 Accepted: 26 October 2015 Citation: European Oncology & Haematology, 2015;11(2):130–3 Correspondence: Ulrich Jager, Medical University of Vienna, Vienna, Spitalgasse 23, 1090 Wien, Austria. E: ulrich.jaeger@meduniwien.ac.at; Martin Hutchings, Department of Haematology, Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark. E: martin.hutchings@gmail.com Support: The publication of this article was supported by Takeda, who were given the opportunity to review the article for scientific accuracy before submission. Any resulting changes were made at the author’s discretion. Chemotherapy achieves excellent response rates and long progression- free survival (PFS) in classical Hodgkin’s lymphoma (cHL) and systemic anaplastic large cell lymphoma (sALCL). 1 However, up to 30  % of patients with advanced HL do not achieve remission or relapse within a few years of initial treatment. 2 Salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (HD+ASCT) is the standard of care for patients with chemosensitive refractory or relapsed cHL. 1 However, the prognosis is poor for patients who relapse following HD+ASCT. 3 Independent risk factors for overall survival (OS) include early relapse (<6 months) after ASCT, stage IV, bulky disease, poor performance status (PS) and age ≥50 years at relapse. 4 For patients with sALCL, the benefits of SCT are less clear, and patients not achieving a complete response (CR) or at least a good partial response (PR) before HD+ASCT usually have a poor prognosis. Moreover, patients that relapse after HD+ASCT have few effective treatment options. In patients with chemo-refractory disease who are otherwise clinically fit, allogeneic stem cell transplantation (allo-SCT) has been shown to have a curative potential as a result of the underlying graft-versus- 130 lymphoma (GvL) effect. However, many patients are unable to undergo allo-SCT, and treatment with brentuximab vedotin (BV) provides an alternative for these patients. On the basis of a number of pivotal clinical trial data, 5 8 BV was granted accelerated approval by the US Food and Drug Administration (FDA) and conditional approval by the European Medicines Agency (EMA) for the treatment of patients with cHL after failure of auto-SCT or after failure of at least two prior chemotherapy regimens in patients who are not auto-SCT candidates, and for the treatment of patients with sALCL after failure of at least one prior combined chemotherapy regimen. This article aims, through a series of case studies, to demonstrate the use of BV in selected patient groups with relapsed/refractory cHL and sALCL. The Use of Allogeneic Stem Cell Transplantation in Relapsed/Refractory Classical Hodgkin’s Lymphoma and Systemic Anaplastic Large Cell Lymphoma The role of allo-SCT in cHL is not well established and is considered controversial. 9 13 The treatment is associated with significant toxicity and results in few long-term disease-free survivors. Reduced-intensity Tou c h ME d ica l ME d ia