Brentuximab-vedotin and bendamustine for relapsed or refractory Hodgkin lymphoma: the LYSA real-world experience

Classical Hodgkin lymphoma (HL) is often cured after modern first line regimen but relapsed or refractory (R/R) diseases remain a therapeutical challenge that has been addressed by little randomized clinical trials. Several combinations of brentuximab-vedotin (Bv) with chemotherapy have been reported in R/R HL so far, yet neither randomized clinical trials nor large scale real world evidence exist that comprehensively picture efficacy and toxicity of these distinct Bv-based regimen. By leveraging real-world data from 222 patients with R/R HL treated in France during 10 years, we showed that brentuximab-vedotin plus bendamustine (B2 regimen) was associated with an overall response rate (ORR), complete response (CR) rate and 2-year progression-free survival (2y-PFS) of 82%, 69.8% and 54.8%, respectively. The 2y-PFS of the 150 patients eligible for transplantation at B2 initiation was 64.2%, and reached 79.9% for the 102 patients in which transplantation was successfully performed, despite an infrequent use of Bv maintenance. Conversely and despite a CR rate of 69.6%, patients ineligible for transplantation faced poor outcomes with a 2y-PFS of 35%. B2 regimen was associated with low hematological toxicities and of neuropathy rates, and was administered as an outpatient treatment in 80% of cases. Considering the fact that Bv combinations might remain important therapy options for R/R diseases, notably after frontline regimen containing checkpoint inhibitors, these results support B2 regimen as a valid combination for patients eligible for transplantation while highlighting ineligible patients as a persistent unmet medical need.