Journal Article

Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma

Guidetti, Anna, Nieto, Yago, Giordano, Laura, Moles-Moreau, Marie-Pierre, Castagna, Luca, Arai, Sally, Spinner, Michael A., Merryman, Reid W., Orvain, Corentin, Armand, Philippe, Lekakis, Lazaros, Stamatoulas, Aspasia, Shouse, Geoffrey, De Colella, Jean Marc Schiano, Shah, Gunjan L., Cohen, Jonathon B., Ramchandren, Radhakrishnan, Phillips, Tycel, Modi, Dipenkumar, Rao, Uttam, Jaglowski, Samantha, Joyce, Robin M., Houot, Roch, Bouabdallah, Kamal, Nishihori, Taiga, Dahncke, Lori, Lowsky, Robert, Mohty, Mohamad, Beitinjaneh, Amer, Singh, Anurag K., Manson, Guillaume, Smith, Stephen D., Bond, David A., Perales, Miguel-Angel, Svoboda, Jakub, Torri, Valter, Carlo-Stella, Carmelo, Casadei, Beatrice, De Philippis, Chiara, Feldman, Tatyana A., Bashey, Asad, Nathan, Sunita, Lynch, Ryan C., Zinzani, Pier Luigi, Chen, Yi-Bin, Ansell, Stephen M., Serritella, Anthony V., Frigault, Matthew J., Ho, Vincent T., Ballard, Hatcher J., Hamadani, Mehdi, Romancik, Jason T., Blaise, Didier, Dulery, Remy, Santoro, Armando, Byrne, Michael, Corradini, Paolo, Spilleboudt, Chloe, Sollini, Martina, Chavez, Julio, Rahimian, Maryam, Ma

2021

Overview

Anti-PD-1 monoclonal antibodies yield high response rates in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but most patients will eventually progress. Allogeneic hematopoietic cell transplantation (alloHCT) after PD-1 blockade may be associated with increased toxicity, raising challenging questions about the role, timing, and optimal method of transplantation in this setting. To address these questions, we assembled a retrospective cohort of 209 cHL patients who underwent alloHCT after PD-1 blockade. With a median follow-up among survivors of 24 months, the 2-year cumulative incidences (CIs) of non-relapse mortality and relapse were 14 and 18%, respectively; the 2-year graft-versus-host disease (GVHD) and relapse-free survival (GRFS), progression-free survival (PFS), and overall survival were 47%, 69%, and 82%, respectively. The 180-day CI of grade 3–4 acute GVHD was 15%, while the 2-year CI of chronic GVHD was 34%. In multivariable analyses, a longer interval from PD-1 to alloHCT was associated with less frequent severe acute GVHD, while additional treatment between PD-1 and alloHCT was associated with a higher risk of relapse. Notably, post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis was associated with significant improvements in PFS and GRFS. While awaiting prospective clinical trials, PTCy-based GVHD prophylaxis may be considered the optimal transplantation strategy for this patient population.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Springer Nature
• Subject: 631/250/1904 / 692/699/67/1990/291/1556 / Cancer Research / Care and treatment / Cellular proteins / Clinical trials / Critical Care Medicine / Cyclophosphamide / Development and progression / Disease prevention / Genetic aspects / Graft versus host disease / Graft-versus-host reaction / Health aspects / Hematology / Hodgkin's disease / Hodgkin's lymphoma / Intensive / Internal Medicine / Life Sciences / Lymphoma / Medicine / Medicine & Public Health / Monoclonal antibodies / Oncology / Patients / PD-1 protein / Questions / Stem cells / Survival / Toxicity / Transplantation / Transplants & implants