1. Anas Younes, M.D. Memorial Sloan Kettering Cancer Center
Recurrent HL after Auto Transplant in CR on Brentuximab Vedotin: Allo Transplant or Maintenance Therapy?
Anas Younes, M.D.
Memorial Sloan Kettering Cancer Center

2. Relapse After ASCT: OS by Era of Transplant
Overall Survival
<1990 median 1.9 yrs
median 2.6 yrs
>2000* median 1.9 yrs
>2000 vs : P (Gehan) = .02, P (logrank) = .03
Arai S et al, Leukemia and Lymphoma 2013

3. or GVD after failing a prior transplant (dashed line).
Gemcitabine, Vinorelbine, and Pegylated Liposomal Doxorubicin (GVD) Followed by Autologous Stem-Cell Transplant (solid line)
or GVD after failing a prior transplant (dashed line).
Bartlett N et al. Ann Oncol 2007;18:

4. 94% (96 of 102) of patients achieved tumour reduction
Brentuximab Vedotin: Pivotal Phase II Trial Maximum Tumour Reduction per IRF
94% (96 of 102) of patients achieved tumour reduction
Individual patients (n=98*)
Tumour size (% change from baseline)
100 50
–50
–100
Complete remission by PET
Younes et al. JCO 2012

5. Brentuximab Vedotin: Pivotal Phase II Trial PFS Results by Best Response
Phase II pivotal study of brentuximab vedotin in 102 patients with relapsed/refractory HL post ASCT: PFS by best response

6. Summary Results of Phase I/II Single Agents in Patients with Relapsed HL
Response rate (%)
Younes a, Hematology/Oncology Clinics of North America 2013

7. Single Agent Activity of New Agents in Post SCT Relapsed cHL Comparison to multiagent chemotherapy GVD
% Response rate
Younes a et al. ASCO 2012

8. Brentuximab Vedotin Initial treatment vs. Retreatment
HL sALCL
N= N=15
N= N=8
Bartlet et al. ASCO 2012

12. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin’s lymphoma. Results of the HDR-ALLO study – a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
Sureda A, et al: Haematologica February; 97(2): 310–317.

13. RIC and Allo SCT for Relapsed/Refractory HL
Non Relapse Mortality
Relapse Incidence
Impact of disease chemosensitivity on relapse incidence.
Sureda A, et al: Haematologica February; 97(2): 310–317.

14. RIC and Allo SCT for Relapsed/Refractory HL
PFS

15. 70% of HRS cells have B2MG mutations
Integrated Genomic Analysis of Flow Sorted Hodgkin and Reed-Sternberg Cell in Primary Classical Hodgkin Lymphoma Jonathan Reichel (New York, USA)
70% of HRS cells have B2MG mutations

16. Allo Transplant for Relapsed cHL?
ABVD
N=100
Relapse/Refractory
(n=30)
Respond to salvage therapy and offered ASCT
(n=24)
Cured with ASCT
(n=12)
R/R to ASCT
Respond to salvage therapy and have a suitable donor
(n=6)
20% TRM + 40% relapse
(n=4)
Cured with allo SCT
(N=2) with GVHD
Refratory or no suitable donor
ASCT ineligible
Cure
(n=70)

17. Proposed Algorithm for Treating Patients Post ASCT
<CR/Relapse
Brentuximab Vedotin CR
Observe
<CR
Consider allo SCT
Consider evaluation for B2MG mutations
Observe (Role of adjuvant BV?)