Bendamustine in combination with ifosfamide, etoposide, and vinorelbine (VIBE) is an effective salvage regimen for heavily pre-treated patients with relapsed or refractory Hodgkin lymphoma: a single-center experience
Gaurav Prakash1, Arihant Jain1, Kamalkant Sahu1, Amanjit Bal2, Charanpreet Singh1, Rajender Basher3, Harmandeep Singh3, Kundan Mishra1, Aditya Jandial1, Deepesh Lad1, Alka Khadwal1, Radhika Srinivasan4, Ashim Das2, Neelam Varma5, Subhash Varma1, Pankaj Malhotra1
1Clinical Hematology and BMT Division, Department of Internal Medicine, 2Department of Nuclear Medicine, 3Department of Histopathology, 4Department of Cytopathology, 5Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence to: Pankaj Malhotra, M.D.
Clinical Hematology and BMT Division, Department of Internal Medicine, F block, 4th floor, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
E-mail: malhotrapankaj@hotmail.com
Published online: August 12, 2021.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE).
Methods: Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT).
Results: In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3-76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity; it was observed in 42% of patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicity in our cohort of patients.
Conclusion: In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
Keywords: Relapsed refractory, Hodgkin Lymphoma, Salvage, Bendamustine, Autologous transplant


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