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We examined real-world data on management of relapsed/refractory Hodgkin lymphoma (R/R HL) in five European countries and the consistency of these data with guideline recommendations. Retrospective clinical and epidemiologic data for 509 patients with R/R HL treated between January 2014 and March 2015 were collected at centers in France, Germany, Italy, Spain, and the United Kingdom. Mean age was 46.3 years; 73.3% were receiving second-line therapy for a first relapse during the reporting period. Most patients received ABVD as front-line chemotherapy, except in Germany where escalated BEACOPP was used more often. The proportion of patients receiving stem cell transplantation (SCT) was 44%; 85% of transplants occurred at first relapse. Brentuximab vedotin (BV) was usually administered after autologous SCT, and was initiated for 65% of patients following SCT failure. Our findings suggest that R/R HL management across these countries is broadly consistent with guideline recommendations and that BV is well-integrated into treatment pathways. [ABSTRACT FROM AUTHOR]

Classical Hodgkin lymphoma (cHL) is the most common hematological malignancy in young adults and can be cured in most cases. However, relapsed and refractory Hodgkin lymphoma, certain patient groups, such as elderly patients, and toxicity of first-line treatment still pose significant challenges. Consequently, new treatment options are needed. Recently, many new treatment concepts have been evaluated in clinical trials. Targeted drug-antibody conjugates and immune checkpoint inhibitors have decisively changed treatment approaches. This review aims to give a comprehensive overview of novel agents in Hodgkin lymphoma that have been recently or are currently being evaluated in clinical trials. In addition to dedicated sections on brentuximab vedotin (BV) and immune checkpoint inhibitors, other emerging substances and concepts are discussed. In doing so, this review compares trial results regarding safety and efficacy. A special focus lies on the effect novel agents will have on the different treatment settings faced by clinicians involved in the treatment of Hodgkin lymphoma. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the use of the oral deacetylase inhibitor panobinostat to treat patients with Hodgkin lymphoma. The study examined 27 patients who received panobinostat and 14 patients who were given placebos. The results revealed relapse in patients after they received high dose chemotherapy and underwent autologous stem cell transplants.

Background Hodgkin lymphoma (HL) is one of the most common malignancies in young adults and one of the most curable cancers worldwide. With interim PET-scan, HL treatment is in the process of being modified: a negative or positive interim PET separates good and poor responders to initial therapy; therefore, deescalated or escalated additional treatment is currently being evaluated in clinical trials. Methods The Cochrane Library, MEDLINE and conference proceedings were searched until 05.2015 for randomized controlled trials (RCTs) comparing FDG-PET-adapted therapy to standard treatment in untreated early stage HL patients with a negative PET-scan. Two review authors independently screened search results and extracted relevant study data. Hazard ratios (HR) were used for time-to-event data and risk rations (RR) for dichotomous data, with 95% confidence intervals (CI). If trials were considered sufficiently clinically homogenous, fixed-effect model was used to pool data. Results Three RCTs involving a total of 1480 participants were included in the meta-analysis. Only one trial provided data for OS, without evidence for a difference between both arms (HR 0.51; 95% CI 0.15–1.68). All three trials assessed progression free survival, which was inferior in the PET-adapted arms (without radiotherapy) compared to the standard treatment arms (HR 2.40; 95% CI 1.63–3.53). Adverse events were reported in one study only, without evidence for a difference between both arms. There were no data on long-term adverse events, quality of life and treatment-related mortality available Conclusion To date, no robust data on survival and adverse events are available. However, this systematic review found that PFS was significantly decreased in the PET-adapted treatment arm (without radiotherapy) in early stage HL patients. [ABSTRACT FROM AUTHOR]

Only limited data are available on the role of brentuximab vedotin (SGN-35) in transplant-naive relapsed or refractory patients with Hodgkin lymphoma (HL). We thus retrospectively analyzed 14 patients with primary refractory or relapsed HL who were treated with brentuximab vedotin as single agent in a named patient program, who had not received prior high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) due to refractory disease ( n = 9), comorbidity ( n = 4) and unknown reasons ( n = 1). Brentuximab vedotin resulted in an overall response rate of 71% (10/14) with five complete responses (CRs). Five of those patients with refractory disease and four patients with relevant comorbidity responded. Consolidating ASCT ( n = 4) or allogeneic SCT ( n = 1) was performed in five patients. Median progression-free survival (PFS) was 9 months and the median overall survival (OS) was not reached. These data indicate the therapeutic efficacy of brentuximab vedotin in chemotherapy-refractory transplant-naive patients with HL. [ABSTRACT FROM AUTHOR]

Background: With an incidence of 2 to 3 cases per 100 000 persons per year, Hodkgin's lymphoma (HL) is rare, but nonetheless one of the most common cancers in young adults. Improved treatment has made HL curable even in advanced stages, but controversy still surrounds a number of issues in patient care. Current research focuses on the avoidance of long-term adverse effects and secondary malignancies. Methods: We selectively searched MEDLINE, CENTRAL, and the Guideline International Network for publications about HL. Two experts independently screened the retrieved publications for pertinence and extracted data from potentially relevant meta-analyses, randomized controlled trials (RCTs), and cohort studies into evidence tables. Results: 32 key questions were answered with 160 recommendations on the basis of evidence from 43 RCTs, 21 meta-analyses, and 119 cohort studies. Patients in an early stage of HL should be treated with two cycles of ABVD followed by involved-field radiotherapy (IF-RT) at a dose of 20 Gy (5-year overall survival [OS]: 94%). Patients in an intermediate (early unfavorable) stage should be treated with two cycles of BEACOPP escalated followed by two cycles of ABVD and 30 Gy IF-RT (5-year OS: 97.2%). Patients in an advanced stage should be treated with six cycles of BEACOPP escalated, and the decision whether this should be followed by consolidating radiotherapy (30 Gy) should be based on the findings of positron-emission tomography (radiate in case of PET-positive residual tumor; 5-year OS: 95.3%). Depending on the treatment regimen, there may be adverse effects including infection, leukopenia, anemia, thrombocytopenia, secondary neoplasia, and fertility disorders. Conclusion: Most questions in the treatment of HL can now be answered on the basis of sufficient evidence from the literature. This holds in particular for the potential benefit to be gained from PET, follow-up care, and lifestyle recommendations for patients. [ABSTRACT FROM AUTHOR]

The optimal treatment of patients with relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is ill defined. To shed more light on treatment options and outcome, we performed an analysis using the database of the German Hodgkin Study Group (GHSG). Ninety-nine patients who had received first-line treatment within 12 prospective GHSG studies conducted between 1993 and 2009, and subsequently developed disease recurrence (n = 91) or had primary disease progression (n = 8), were included. At initial NLPHL diagnosis, the median age was 40 years and 76% of patients were male. First-line treatment consisted of radiotherapy (RT) alone (20%), chemotherapy with or without RT (74%), and the anti-CD20 antibody (Ab) rituximab (6%), respectively. The median follow-up from initial diagnosis was 11.2 years. The median time to disease recurrence was 3.7 years. The applied salvage approaches included single-agent anti-CD20 Ab treatment or RT alone (37%), conventional chemotherapy (CT) with or without anti-CD20 Ab treatment with or without RT (27%) and high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) (31%). No salvage treatment was given in 4% of patients. The 5-year progression-free survival and overall survival estimates after NLPHL recurrence were 75.6% and 89.5% (74.1% and 97.2% after single-agent anti-CD20 Ab treatment or RT alone; 68.0% and 77.8% after CT with or without anti-CD20 Ab treatment with or without RT; 84.6% and 89.8% after HDCT and ASCT). Hence, patients with relapsed or refractory NLPHL had a good overall prognosis. Factors such as time to disease recurrence and previous treatment may guide the choice of the optimal salvage approach for the individual patient. [ABSTRACT FROM AUTHOR]

Approximately 20% of all Hodgkin lymphoma (HL) patients are older than 60 years and have a poor prognosis, mainly because of increased treatmentrelated toxicity resulting in reduced overall dose intensity and more treatmentrelated mortality. To possibly improve the treatment of elderly HL patients, the German Hodgkin Study Group developed a new regimen, PVAG (prednisone, vinblastine, doxorubicin, and gemcitabine). In this multicenter phase 2 study, elderly HL patients in early unfavorable and advanced stages received 6 to 8 cycles of PVAG and additional radiotherapy if they were not in complete remission (CR) after chemotherapy. Endpoints included feasibility, acute toxicity, and response rate. Fifty-nine patients 60 to 75 years of age (median, 68 years) were eligible for analysis; 93% had advanced stage disease. WHO grade 3/4 toxicities were documented in 43 patients; 46 patients responded with CR/CR uncertain (78%). Within 37 months median observation time, 15 progressions or relapses and 17 deaths were observed, of which 8 were related to HL and 1 was the result of treatment-related toxicity. The 3-year estimates for overall survival and progression-free survival were 66% (95% CI, 50%78%) and 58% (95% CI, 43%-71 %), respectively. We conclude that PVAG is safe and feasible in elderly HL patients. This trial was registered at www.clinlcaltrials.gov as #NCT00147875. [ABSTRACT FROM AUTHOR]

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for 5% of Hodgkin lymphoma cases. The disease is characterized by a strong CD20 expression on the malignant cells and a more indolent clinical course compared with classic HL. Anti-CD20 antibody treatment has shown clinical activity In relapsed NLPHL. In this phase 2 trial, we Investigated rituximab In newly diagnosed stage IA NLPHL patients. Four weekly applications at 375 mg/m2 were given. Among the 28 evaluabie patients, overall response rate was 100%, 24 patients (85.7%) achieved complete remission, and 4 (14.3%) achieved partial remission. At a median follow-up of 43 months, overall survival was 100%; progression-free survival at 12. 24, and 36 months was 96.4%, 85.3%, and 81.4%, respectIvely. No grade 3 or 4 toxicity was observed, Although treatment results with rituximab appear interior compared with radiotherapy and combined-modality approaches in early-stage patIents, investigation of anti-CD20 antibody-based combinations in NLPHL Is warranted. This study was registered at www.clinicaitrials.gov as #NCT00346684. [ABSTRACT FROM AUTHOR]