I’m caring for a 30M diagnosed with classic HL, nodular sclerosing back in 2016. He started with ABVD which got him to CR but he relapsed within a year. He got salvage therapy with ICE which achieved PR and then went to BEAM conditioning aSCT. He was back in CR after the transplant but declined BV maintenance at the time. He relapsed again a little over a year after his auto and started on BV monotherapy which got him back to VGPR and then he went to RIC (flu/bu) MRD alloSCT. He had scans that showed FDG avid adenopathy in his neck and biopsy has confirmed lymphoma. The BMT team says they’d be willing to do DLI if I get him back into at least a PR. Would BV-benda be reasonable or do you think there’s another regimen i should reach for? He’s still got an excellent performance status. Although he never got to CR on BV he also never progressed on it, so that’s why I was thinking I could re-challenge him.
That's a challenging case indeed. You can do BV Benda which has shown excellent response but was associated with signficiant toxicity and infections that the BV Benda arm was closed early in the elderly population, it is also very myelosuppressive and might lead to damage of his allo graft. I now lean to incorporating PDL1 inhibitors with chemo. An easy option would be BV-Nivo with high responses, other option is GVD-Pembro. Both of those options might enhance his allo immune response and understanbly might increase the risk of GVHD but I think the benefits outweighs the risks.
https://ascopubs.org/doi/full/10.1200/JCO.21.01056
https://ashpublications.org/blood/article/138/6/427/475691/Brentuximab-vedotin-in-combination-with-nivolumab
