Further strategies after immune checkpoint inhibitors in relapsed/refractory Hodgkin lymphoma: salvage treatments and consolidation with transplantation, experience in daily clinical practice

Immune checkpoint inhibitors (CPIs) emerged as an effective and safe therapeutic option for patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). However, many patients lose their response to CPIs. To improve outcomes in this setting, two strategies can be considered: salvage chemotherapy (CHT) for those with an unsatisfactory response, and autologous stem-cell transplantation (auto-SCT) as a consolidation for patients with at least partial response (PR). We analyzed retrospectively the effectiveness in terms of rate of response and survivals of these two approaches in cohort 1 (salvage CHT) and in cohort 2 (auto-SCT consolidation). Adverse events were also assessed. A total of 45 heavily pre-treated patients were analyzed (median of 4 prior therapies; 93.3% refractory to the last therapy). Thirty patients received further CHT at a median of 32 days (range 1-1213) after CPI Fifteen patients in cohort 2 underwent auto-SCT, with 8 in complete response (CR) and 7 in PR. In cohort 1 a final overall response rate (ORR) of 50.0% with a median progression-free survival of 24.6 months. In cohort 2, the ORR was 93.3% (all CR) with median survivals not reached. No unexpected or cumulative toxicities were observed. Our findings suggest that auto-SCT is an effective consolidation strategy for cHL patients who achieve at least a PR after CPI therapy, despite multiple prior lines of treatment. Additionally, CPIs treatment appears to sensitize heavily pre-treated and chemorefractory patients to subsequent chemotherapy, potentially facilitating successful transplant consolidation and improving the chances of cure.