Novel Brentuximab Vedotin Combination Therapies Show Promising Activity in Highly Refractory CD30+ Non-Hodgkin Lymphoma: A Case Series and Review of the Literature.
Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of hematologic malignancies which typically respond to standard first-line chemoimmunotherapy regimens. Unfortunately, patients with refractory NHL face a poor prognosis and represent an unmet need for improved therapeutics. We present two cases of refractory CD30+ NHL who responded to novel brentuximab vedotin- (BV-) based regimens. The first is a patient with stage IV anaplastic large cell lymphoma (ALCL) with cranial nerve involvement who failed front-line treatment with cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP) and second line cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate (MTX), and cytarabine (hyperCVAD) with intrathecal- (IT-) MTX and IT-cytarabine, but responded when BV was substituted for vincristine (hyperCBAD). The second patient was a man with stage IV diffuse large B-cell lymphoma (DLBCL) with leptomeningeal involvement whose disease progressed during first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and progressed despite salvage therapy with rituximab, dexamethasone, cytarabine, and cisplatin (R-DHAP) in whom addition of BV to topotecan resulted in a significant response. This report describes the first successful salvage treatments of highly aggressive, double refractory CD30+ NHL using two unreported BV-based chemoimmunotherapy regimens. Both regimens appear effective and have manageable toxicities. Further clinical trials assessing novel BV combinations are warranted.
Hematology/Oncology Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Wilfred
0000-0001-5363-6975
W
Delacruz
Hematology/Oncology Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Robert
R
Setlik
Department of Internal Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Arash
A
Hassantoufighi
Department of Internal Medicine, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Shyam
S
Daya
Hematology/Oncology Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Susannah
0000-0002-9015-7954
S
Cooper
Department of Pathology, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Dale
D
Selby
Hematology/Oncology Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA.
Alexander
A
Brown