Pb2062: epidemiological, clinical and therapeutic features of refractory hodgkin’s lymphoma.

Background: Approximately 10 to 15 percent of patients have refractory Hodgkin’s lymphoma (HL) that either does not respond to initial therapy or progresses after an initial partial response. Refractory HL poses a major problem of care, especially since there is currently no consensus regarding second or third line chemotherapy. Aims: The objective of our study is to report the epidemiological, clinical and therapeutic features of patients with refractory HL to first-line chemotherapy. Methods: This is a retrospective study including 32 patients with refractory HL treated during the period from 2015 to 2020. The patients received the first line chemotherapy according to the national MDH 2015 protocol. Results: The median age of our patients was 33 years old (17-64years) with a sex ratio of 0.88. B symptoms at diagnosis were present in 53% of cases. Localized stage (II) and extented stages (III and IV) were observed in 25% and 75%, respectively. Tumor bulky (≥7cm) was present in 34.5% of cases. The International Prognostic Score (IPS) ≥3 was present in 31% of patients. Frontline treatment was ABVD chemotherapy in 4 patients with PR in 3 cases, progression in 1 case and BEACOPP-R chemotherapy in 28 patients with PR in 15 cases, failure in 8 cases and progression in 5 cases. First line salvage therapy was DHAP chemotherapy in 13 patients with CR in 2 patients, PR in 1 patient, failure in 3 patients, progression in 4 patients and toxic death in 3 patients. For patients refractory to DHAP (8patients), 7 patients received the second line salvage therapy which was IGEV in 2 patients with obtaining a PR in 1 patient and progression in the other patient and Bendamustin-Brentuximab (BB) in 5 patients with obtaining a CR in 3 patients and progression in 2 patients. First line salvage therapy was IGEV chemotherapy in 16 patients with CR in 4 patients, PR in 3 patients and progression in 9 patients. For patients refractory to IGEV (12patients), the second line therapy was DHAP with obtaining a CR in 2 patients, toxic death in 4 patients and failure in 4 patients who received (BB) as third line therapy without response. First line salvage therapy was BB chemotherapy in 3 patients with obtaining a CR in 1 patient and death during chemotherapy in 2 patients. For good responders after salvage therapy (11 /32 patients), autologous stem cell transplant (ASCT) was performed only in 3 patients. The 5 years overall survival and relapse free survival were 49% and 18%, respectively. Summary/Conclusion: Our results are much lower than the literature with a mediocre survival of these refractory forms encouraging the introduction of BB as protocol of salvage therapy and the respect of the ACSP in the good responders.