What second-line regimen should we use for recurrent Hodgkin lymphoma prior to stem cell transplant? Pankaj Malhotra, MD

1. What second-line regimen should we use for recurrent
Hodgkin lymphoma prior to stem cell transplant?
Pankaj Malhotra, MD
PGI, Chandigarh, India

2. Outline of talk
• Why auto is better than continuing chemo in relapsed HL?
• Results of auto transplant in relapsed HL
• Predictors of transplant outcome
• Chemotherapy regimens used before transplant
• Does any specific chemotherapy regimen make diff in outcome?
• Upcoming therapies

3. Chemotherapy vs Autologous SCT in relapsed HL
Results of randomized trials

6. ABMTR data and multicentric studies data on
autologous SCT in relapsed HL

13. Summary
• Autologous stem cell transplantation improves EFS and PFS in
relapsed HL
Factors predicting poor outcome
• B symptoms
• Stage IV disease at relapse
• Residual disease at the time of transplantation
• More than three prior chemotherapies (chemo-resistant disease)

14. Further predictors of outcome

19. Regimens used before transplant

20. Best salvage regimen
• Effective/High response rates
• Out patient administration
• Minimal effect on stem cell mobilisation
• Minimal toxicity

21. 60-88% 17-56% 0-9%

22. 69-89% 17-60%

27. Upcoming therapies

36. Conclusions
• ORR of salvage chemotherapy regimens in relapsed refractory HL vary
from 60-80%
• CR rates vary from 20-40%
• Brentuximab as a single agent is able to achieve ORR and CR rates
similar to chemotherapy regimens
• The available data is thus compelling enough to recommend use of
Brentuximab in relapsed refractory HL before auto or allogeneic stem
cell transplantation