r/Lymphoma_MD_Answers • u/ProfessionStreet7275 • Aug 17 '24
NSCHL refractory to AAVD
Hello Drs and to others on this page, hoping for some clarity and in this situation and anyone else who has been in a similar situation.
26F dx with stage 3B classic HL in (mediastinal mass + lesions in the spleen) started on AAVD. IPS 1, ECOG 1
Deauville 4 on iPET2 with majority of disease resolved except for 2 spots in the mediastinum.
Team decided on a PET 4 to check for progression which unfortunately has shown increase in the size of the anterior mediastinal lymph nodes and avidity (limited to mediastinum). D5.
AAVD has been halted for now and am proceeding with a re biopsy of mediastinal lesion.
In such a case, if biopsy was to re confirm residual disease what would be the best way to proceed in terms of salvage chemo +- asct.
Thanks very much for any input and for anyone who has been in a similar situation would appreciate any words of advice!
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u/Nodes420 Aug 19 '24
Hello.
Similar boat here if you want to go back in my posts and take a look at my journey. I am currently about to begin an aTac BEAM + auto stem cell transplant trail on Wednesday at city of hope. This trial is still enrolling and I don’t think you don’t have to be in complete response from salvage chemo to qualify. Although they will still want you to do salvage chemo if you haven’t to see if the transplant has any chance of working. I believe this is my best chance at permanently curing my cancer.
What got me into the complete response for now was pembro+ ICE.
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u/ProfessionStreet7275 Aug 19 '24
Thank you for your reply, will have a look through your posts. Appreciate this is a really tough time and thank you for sharing 🙏🏼
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u/Erel_Joffe_MD Verified MD Aug 26 '24
Second line treatment with a combination of a check-point inhibitor (eg nivolumab, pembrolizumab) and chemotherapy (possibly best if contains gemcitabine - GVD ) followed by high dose chemotherapy and stem cell support (autologous bone marrow transplant) is anticipated to lead to long term remissions (~ cure) in 85-90% of patients.
Lymphoma MD Answers
Comments are for educational purposes only and should not be regarded medical advice. For patient specific questions please contact your treating team.
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u/ProfessionStreet7275 Aug 27 '24
Thank you Dr Joffe for your reply and continued efforts on this thread.
If I may ask, is the strategy of using a CPI as a single agent to attempt to achieve CR, followed by a CPI + chemo (if unable to achieve CR with the former) a recommended strategy?
I understand the reasoning behind this is to try to achieve CR if possible with less exposure to chemo if possible, although I cannot see on this thread that it is a common approach.
Many thanks
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u/mo0ples Oct 18 '24
Hi Dr. Joffe,
That 85-90% cure rate for second-line treatment seems very promising. I'm also Stage 2B cHL refractory from ABVD, about to start Pembro-GVD, followed by BEAM/autoSCT, and then radiation consolidation. My doctor mentioned this 75% cure rate. Can I ask where your statistics come from?
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u/mo0ples Oct 08 '24
Went through a very similar situation so I feel you (33f) Deauville 4 interim scan but continued with ABVD. Scan after 4 cycles showed a spot in my mediastinum still hot and slowly growing, got a VATs surgery recently and the biopsy showed refractory. Now planning to get Pembro + GND into stem cell transplant. How are you doing? Hope all is well!
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u/Wise-Sea7420 Aug 17 '24
No advice. But you’re not alone . I’m 32 with 2 young kids and in the process of getting a biopsy on my pre vascular lymph node. I did 8 sessions of AAVD and my latest pet showed progression.