Examining Targeted Therapies for Hodgkin Lymphoma in the Transplant Setting: Reason for Optimism - a BMTR Publication
Hodgkin lymphoma (HL) is a patho¬logically and clinically heterogeneous hematologic malignancy. In the United States, an estimated 185,000 people are currently living with this disease, and it accounted for more than 9,000 new cases of cancer in 2015. Chemotherapy and radiation provide long-term benefit to the majority of patients with HL; however, some patients will eventually relapse.
High-dose chemotherapy followed by autologous stem cell transplant (ASCT) is the standard of care for relapsed disease, resulting in complete remission rates of approximately 50%. However, patients who relapse after ASCT generally have poor outcomes, with 5-year overall survival rates as low as 12% in patients with multiple poor prognostic factors. In an attempt to prolong the benefit of ASCT in relapsed/refractory HL, chemotherapy and targeted therapy regimens have been tested as consolidation therapy. However, finding an appropriate bal¬ance between efficacy and tolerability has remained challenging. Since ther¬apy options in the relapsed/refractory setting are limited, the discovery of new, well-tolerated agents that may improve the benefit of ASCT has been a high priority.
One of the most recent therapies to be approved for the management of HL was brentuximab vedotin. This antibody-drug conjugate combines an anti-CD30 monoclonal antibody with a cytotoxic chemotherapy to deliver a tar¬geted, cytotoxic payload to tumor cells. In its pivotal study for HL treatment, brentuximab vedotin demonstrated high response rates and favorable overall sur¬vival in patients who had failed prior chemotherapy and ASCT. More recently, researchers have explored brentuximab vedotin as consolidation therapy post- ASCT. The results of this study showed that brentuximab vedotin improves pro¬gression-free survival in patients with risk factors for progression with manage¬able toxicity.
Researchers also have placed a high priority on discovering factors that can help predict the risk of relapse following ASCT. Such a risk assessment would help identify patients for whom consolidation therapy should be considered. Fluoro¬deoxyglucose-positron emitting tomog¬raphy (FDG-PET) has been established as an important prognostic tool for early HL. More recently, however, it has been studied as a tool for assessing the risk of ASCT failure. Specifically, patients with residual HL detectable by FDG-PET after high-dose chemotherapy are at greater risk for progression following ASCT.
Accreditation Statement for Joint Provider Activities:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of The Medical College of Wisconsin and Carden Jennings Publishing. The Medical College of Wisconsin is accredited by the ACCME to provide continuing medical education for physicians.
AMA Credit Designation Statement:
The Medical College of Wisconsin designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Hours of Participation for Allied Health Care Professionals:
The Medical College of Wisconsin designates this activity for up to 1.0 hours of participation for continuing education for allied health professionals.
This activity has been developed and is intended for hematologists, oncologists, bone marrow transplant (BMT) specialists and other healthcare professionals involved in the treatment of patients with HL.
Upon completion of the program, participants should be able to:
- Define patients with high-risk Hodgkin Lymphoma (HL) due to known risk factors both at the time of initial diagnosis, as well as the relapsed/refractory setting
- Describe the role of interim fluorodeoxyglucose-positron emission tomography (FDG-PET) to assess responsiveness of the disease to therapy
- Consider which patients may be candidates for targeted consolidation therapy post-autologous stem cell transplant (ASCT)
- Discuss the targeted therapies currently approved or in clinical trials for post-transplant therapy
PASSWORD FOR POSTTEST IS: V25N2
Jack W. Hsu, MD,
No relevant financial relationships to disclose.
John R. Wingard, MD,
No relevant financial relationships to disclose.
In accordance with the ACCME® standards for Commercial Support Number 6, all in control of content disclosed any relevant financial relationships. These relationships were reviewed via the MCW conflict of interest resolution process and resolved:
Stephen Ansell, MD, PhD,
Has received research funding stipends from Bristol-Myers Squibb, Seattle Genetics, and Celldex.
John W. Sweetenham, MD, FRCP, FACP,
Has received speaker honoraria and advisory board honoraria from Seattle Genetics.
- 1.00 AMA PRA Category 1 Credit(s)™AMA PRA Category 1 Credit(s)™
- 1.00 Hours of ParticipationHours of Participation credit.