Background: Brentuximab vedotin (BV) is an antibody-drug conjugate against CD30 used for Hodgkin lymphoma (HL). Although generally well-tolerated, BV commonly results in peripheral neuropathy, nausea, and fatigue. Prior single-agent studies of BV report alopecia as relatively uncommon; however, in practice, the prevalence and duration of alopecia in BV-treated patients seems higher. In this single-center, retrospective study, we characterize BV-associated alopecia in children and young adults with newly diagnosed HL.
Methods: Eligible patients had received >=1 BV dose for newly diagnosed HL, had no pre-existing alopecia, and had >=8 weeks follow-up (including information on alopecia) after last BV dose. Alopecia was graded according to CTCAE v5.0. Between-group comparisons were completed using Fisher’s exact and Wilcoxon rank sum tests. Continuous variables were presented as median (interquartile range).
Results: Of 23 included patients (age: 11-34 years), 23 (100%) developed alopecia after BV. Eighteen (78%) patients were treated with BV-AVD and 5 (22%) received BV-AVEPC. Median time to alopecia onset from first BV dose was 41 (28, 58) days; among BV-AVEPC patients, time to onset trended earlier at 23 (22, 42) days as compared to BV-AVD at 45 (31, 58) days (p=0.3). Seventeen (74%) patients had adequate data to grade hair loss; 16 (70%) patients experienced >=50% hair loss from baseline. Nine (39%) patients did not have full resolution of alopecia, despite a median follow-up time of 3.1 (2.1, 3.4) years, although all have experienced some improvement in hair loss. Eight (35%) patients were referred to Dermatology and/or started treatment for alopecia. For the 14 (61%) patients with alopecia resolution, median time to resolution was 186 (117, 280) days from last BV dose. BV-AVEPC patients trended toward a shorter time to alopecia resolution of 122 (103, 149) days versus BV-AVD at 203 (140, 301) days (p=0.2).
Conclusions: In this cohort, alopecia arose in all patients, tended to be severe and diffuse, and did not fully resolve in 39% of patients, despite a median follow-up of >3 years. No risk factors for prolonged alopecia were identified. Alopecia may arise and resolve more quickly in patients treated with BV-AVEPC as compared to BV-AVD, which may reflect the different BV doses and schedules in these regimens. Further research into the mechanisms and management of BV-associated alopecia is needed.
Jonathan D. Bender, Angela T. Faulhaber, Robin E. Norris