The Treatment Pathways, Patient Characteristics and Outcomes in Patients with CD30-Expressing Lymphoma from China: A Multi-Center, Non-Interventional, Retrospective Study
Authors: Miao Yi , Li Wenyu , Ding Kaiyang , Li Fei , Yan Xiaojing , Zhou Xiaoxi , Li Caixia , Cui Guohui , Zou Liqun , Xiu Bing , Zhou Xiangxiang , Zhang Liansheng , Zhou Fuling , Jing Hongmei , Wang Jianli , Guo Ziheng , Li Jianyong 
Published: December 2024

Introduction: CD30 is overexpressed in several lymphoma types, such as classic Hodgkin lymphoma (cHL) and anaplastic large cell lymphoma. New therapies such as CD30 ADC have been approved for CD30-expressing lymphoma in China. However, there are few data on the treatment pathways and demographic characteristics of patients with CD30-expressing lymphoma in China. Herein, we examine the treatment pathways, patient characteristics and outcome in the Chinese population.

Methods: A multi-center, non-interventional, retrospective study (REALM) of newly diagnosed or relapsed/refractory CD30-expressing lymphoma patients aged ≥18 years who received treatment from January 1, 2018, to March 31, 2021. The patients were divided into two cohorts: cHL and non-classical Hodgkin's lymphoma (NHL). The primary endpoint was treatment pathways, and the secondary endpoints were patient demographics/clinical characteristics and outcomes such as real-world objective response rate (rwORR). All data were analyzed using descriptive statistics.

Results: A total of 1010 patients from the Haematology or Oncology departments of 14 hospitals in different regions of China were identified, of whom 41.0% (414/1010) were cHL patients and 59.0% (596/1010) were NHL patients. The median age of cHL patients was 36.0 years (27.0, 52.0), of which 14.98% (62/414) were ≥60 years old, 60.39% (250/414) were female, 93.52% (101/108) had ECOG ≤1, and 62.74% (197/314) had advanced disease (Ann-Arbor stage III-IV). In NHL patients, the median age was 55.0 years (43.0, 65.0), of which 38.76% (231/596) were ≥60 years old, 56.54% (337/596) were female, 81.29% (126/155) had ECOG ≤1, 66.67% (276/414) had advanced disease, and the most frequent diagnosis of CD30+ case were diffuse large B cell lymphoma (49.16%, 293/596), systemic anaplastic large cell lymphoma (15.27%, 91/596), angioimmunoblastic T-cell lymphoma (10.91%, 65/596) and extranodal Natural killer/T-cell lymphoma (10.91%, 65/596).

The proportion of cHL patients receiving 1L, 2L, and 3L+ was 85.99% (356/414), 8.45% (35/414), and 5.56% (23/414), respectively. In contrast, NHL patients received a higher proportion of 1L, 91.61% (546/596), 2L and 3L+ were 5.03% (30/596) and 3.36% (20/596), respectively.

In cHL patients, the most common regimens in the 1L and 2L were ABVD (1L: 66.85%, 238/356; 2L: 14.29%, 5/35), PET-adapted ABVD (1L 23.31%, 83/356; 2L 11.43%, 4/35), and anti-PD-1 regimen (1L anti-PD-1+AVD, 1.40%, 5/356; 2L anti-PD-1, 8.57%, 3/35). Median duration of 1L and 2L drug therapy was 6.0 and 5.0 cycles. 3L+ regimens were mainly based on anti-PD-1 regimen (including anti-PD-1 alone or PET-adapted anti-PD-1), in addition to new drugs such as CD30 ADC, and median duration was 15.0 cycles. CHOP-like regimen (1L 71.14%, 387/544; 2L 46.67%, 14/30) was the most common therapy used options in NHL patients, whether in 1L or 2L. R-EPOCH (2.57%, 14/544) and P-GemOx (2.02%, 11/544) were also commonly used as 1L, and median duration was 6.0 cycles. Treatment pathways were more variable in 2L and 3L+ of NHL patients, including CAR-T therapy, chidamide or CD30 ADC and other drugs, and median duration was 4.0 and 2.5 cycles, separately.

The proportion of patients receiving radiotherapy and hematopoietic stem cell transplantation (HSCT) was lower. 45 and 13 patients with cHL and 57 and 28 patients with NHL, respectively.

The rwORR of 1L, and RR patients with cHL was 80.60% (CR 41.79%) and 51.5 % (CR 27%), respectively. The rwORR of NHL patients with 1L was similar like that of cHL (78.55%, CR 44.16%), but the rwORR fro RR patients (10%,CR 10% ) was lower. During the 1L, 2L and 3L+, 10.67% (38/356), 28.57% (10/35) and 17.39% (4/23) of cHL patients progressed and no patient died. The median follow-up time was 4.67, 5.19 and 10.55 months, respectively. At a median follow-up of 4.53, 4.47 and 7.39 months for 1L, 2L and 3L+, the proportion of NHL patients who had progressed was 15.93% (87/546), 10.00% (3/30) and 10.00% (2/20). In addition, four patients each died during 1L and 3L+, respectively.

Conclusions: This study shows that patients are still most often treated with chemotherapy-based regimens, but new drugs such as anti-PD-1 and CD-30 ADC have gradually emerged. This study initially showed a lower CR than clinical trials, suggesting that more research should be done in patients with CD30-expressing lymphoma.