Third line Treatment in Relapsed/Refractory Hodgkin's Lymphoma and Aggressive non-Hodgkin Lymphoma after 2nd line ESHAP or GEMOX

Background: Treatment after failure of 2nd line chemotherapy in patients with Hodgkin's lymphoma (HL) or aggressive non-Hodgkin’s lymphoma (NHL) is not well studied. Aim: To assess the value of 3rd line treatment in a cohort of HL and aggressive NHL patients. Methods: This was a retrospective study of patients with relapsed/refractory HL or aggressive NHL treated with 3rd line treatment based on physician choice. Response rate as well as overall survival (OS) and factors affecting it were assessed. Results: Fifteen (41%) out of 37 patients who failed 2nd line received 3rd line. The remaining 22 received single-agent palliative chemotherapy or best supportive care only. Third line treatment was IGEV (ifosfamide, gemcitabine, navelbine) in 7 (47%) patients, lenalidomide in 4 (26%), ESHAP (etoposide, methylprednisolone, cytosine arabinoside, cisplatin) in 2 (13%) and GEMOX (gemcitabine, oxaliplatin) in 2 (l3%). Four (27%) patients achieved complete remission (2 with IGEV and 2 with lenalidomide) and 3 of them underwent autologous stem cell transplantation. One (7%) patient achieved partial response and another one (7%) had stable disease. The median OS for the whole group was 4.7 months. For patients who received 3rd line the OS was significantly longer than those who didn’t (13.4 vs. 3.4 months, p=0.001). Among the whole set of patients, performance status, lactate dehydrogenase, tertiary age-adjusted International Prognostic Index, 3rd line treatment, response to 3rd line and transplantation had significant impact on OS.Conclusion: Third line treatment may be feasible in selected HL and aggressive NHL patients who failed 2nd line.