Pediatric relapsed and refractory classical Hodgkin’s lymphoma: Treatment approaches

Introduction: Therapy of relapsed and refractory (r/r) classical Hodgkin’s lymphoma (cHL) is an unresolved problem in pediatric oncology. Modern therapeutic approaches include second-line chemotherapy in combination with targeted drugs (brentuximab vedotin) and PD-1 inhibitors (nivolumab) with following autologous hematopoietic stem cell transplantation (auto-HSCT). Aim is to present long-term results of r/r cHL treatment using targeted drugs, chemotherapy and auto-HSCT.

Methodology: 73 patients with r/r cHL from 2003 to 2023 were included in the study.

Results: Median age was 14.5 years. The diagnosis of r/r cHL was confirmed by pathology and immunohistochemistry. Sites of involvement were detected by PET-CT. Second-line therapy was carried out according to the following regimens: ICE (n = 23; 31.5 %), ViGePP (n = 15; 20.5 %), DHAP (n = 6; 8.2 %), IEP/ABVD (n = 6; 8.2 %); 7 (9.6 %) patients underwent a change in treatment regimen due to a poor response to the first 2 courses of therapy.

Sixteen (21.9 %) patients were treated according to the ViGePP regimen with the addition of brentuximab vedotin (6 injections). 64 (87,7%) patients underwent auto-HSCT. 9 (12,3%) not received auto-HSCT because of disease progression (n=2), medical contraindications (n=3), late relapse (n=4) (according to local protocol, patients with late relapse are non transplanted). The 10-year overall survival in patients with r/r cHL was 76 ± 6 %, relapse-free survival (RFS) was 64 ± 6 %. Patients receiving brentuximab vedotin in combination with the ViGePP regimen had the highest RFS – 83 ± 15.2 % (p = 0.09).

Conclusion: The most effective 2d-line therapy in r/r cHL was brentuximab vedotin+ViGePP with the following auto-HSCT. Patients with late relapse and complete remission after 2d-line therapy were non transplanted and alive.