DR VOSE: So, 34-year-old woman who had ABVD, relapsed within a year, underwent an autologous stem cell transplantation for advanced-stage Hodgkin’s, and then again relapsed within a year with disseminated disease. So she did receive brentuximab vedotin for 3 cycles, and then another PET scan was done and she had a complete remission. So, the question is, how long do you continue to give the brentuximab vedotin? Or do you consider a young patient to go on to an allotransplant at that point?
DR LOVE: So I’ll ask Chris. What would you be thinking?
DR FLOWERS: So that’s always challenging. I mean, unlike some of the other places where we’ve talked about the role of allotransplant in CLL and in mantle-cell lymphoma and follicular lymphoma, while I’ve done a series of allotransplants for patients in the past in Hodgkin lymphoma, less commonly doing those now, because while that provides some benefit and buys time, I’ve seen relatively few long-term disease-free survival patients. And so I’d be a little bit less inclined to do that. And it’s a very challenging situation for a patient with Hodgkin lymphoma who’s relapsed after autologous transplant, because there are relatively few meaningful options at that point. Brentuximab vedotin is likely one that, once you stop therapy, that this patient is ultimately going to relapse again.
We’ve participated in a number of trials for patients in this setting, notably panobinostat recently. That does not appear like it’s likely to pan out, although it showed some promise. RAD-001, that showed some early promise but does not feel like it’s going to pan out. And so among the trials, unlike some of the other situations for the non-Hodgkin’s lymphomas, we haven’t really seen trials pan out in the relapsed situation for Hodgkin lymphoma. So I would likely continue B-vedotin until completion of therapy and then follow this patient. And then, with relapse, consider a chemotherapy-based approach, if necessary, down the line.
DR LOVE: Mike?
DR WILLIAMS: Yes. I’m not as familiar with the allo data that Chris referred to. I guess in a young person, I would still be thinking hard about whether that’s going to be an option to go to. So I mean, typically, I would try to get the response to brentuximab and then refer for that opinion. And I don't know. Are you doing allos at your place?
DR VOSE: We do allos for some of these patients, but it’s, again, a very long discussion and there’s lots of cons, and not as many pros in this situation, just as was discussed. And so I do have some long-term survivors, but they have definitely increased complications, increased infections. So it’s an issue.
DR WILLIAMS: Yes. Because otherwise you’re taking somebody in their mid-30s and I agree. If it’s not good, then we wouldn’t do it. But then you’re already saying you’re not likely to be cured, and so we’re going to try to just sequence therapies and get as much time as possible. So, in that case, since she’s already responded with a CR after 3, then I guess what we’ve done in some patients like that who are not transplant candidates is to just give some truncated version, 6 to 8 doses, stop and then come back with it again down the road when they recur. And the 2 or 3 we’ve done that with have responded again. But you’re into the sequencing, stringing out therapies at that point.