Brentuximab Vedotin Combined with Chemotherapy in Patients with Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma

Brentuximab Vedotin Combined with Chemotherapy in Patients with Newly Diagnosed Early-Stage, Unfavorable-Risk Hodgkin Lymphoma

In the July 10, 2021 edition of Journal of Clinical Oncology, Anita Kumar and colleagues report on the results of brentuximab vedotin combined with chemotherapy in newly diagnosed early-stage, unfavorable-risk hodgkin lymphoma


The purpose of the study was to determine if the addition of radiotherapy to a combination of brentuximab vedotin with triplet chemotherapy for early stage Hodgkin’s lymphoma improved outcomes


In the reported multicenter study with 4 sequential cohorts, patients were offered four cycles of brentuximab vedotin (BV) and doxorubicin, vinblastine, and dacarbazine (AVD). If positron emission tomography was negative, defined as (PET)-4–negative, patients were treated with 30-Gy involved-site radiotherapy in cohort 1, 20-Gy involved-site radiotherapy in cohort 2, 30-Gy consolidation-volume radiotherapy in cohort 3, and were not offered radiotherapy in cohort 4. Eligible patients had early stage, unfavorable-risk disease.  Bulky disease was defined as Memorial Sloan Kettering criteria (> 7 cm in max transverse or coronal diameter on CT scan) was not required for patients in cohorts 1 and 2 but was required for patients in cohorts 3 and 4. The primary end point safety in cohort 1 and to evaluate complete response rate by positron emission tomography for cohorts 2-4.


117 patients were enrolled, 116 completed chemotherapy, with a median age of 32 years. the gender breakdown was as follows 50% men and 50% women. of the 116 patients who completed chemotherapy, 98% had stage II disease, 86% had Memorial Sloan Kettering–defined disease bulkiness, 27% traditional bulkiness (> 10 cm), 52% had an elevated ESR, 21% had extranodal involvement, and 56% at more than 2 involved lymph node sites. The CR rate in cohorts 1-4 was 93%, 100%, 93%, and 97%, respectively. With a median follow-up of 3.8 years (5.9, 4.5, 2.5, and 2.2 years for cohorts 1-4), the overall 2-year PFS and OS were 94% and 99%, respectively. In cohorts 1-4, the 2-year progression-free survival was 93%, 97%, 90%, and 97%, respectively. Adverse events reported were neutropenia (44%), febrile neutropenia (8%), and peripheral neuropathy (54%), which was largely reversible.


The authors concluded that brentuximab vedotin + AVD × 4 cycles is highly active and well-tolerated treatment program for ES, unfavorable-risk Hodgkin lymphoma, including bulky disease. The efficacy of BV + AVD supports the safe reduction or elimination of consolidative radiation among PET-4–negative patients.