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.
Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma / Merryman R.W.; Castagna L.; Giordano L.; Ho V.T.; Corradini P.; Guidetti A.; Casadei B.; Bond D.A.; Jaglowski S.; Spinner M.A.; Arai S.; Lowsky R.; Shah G.L.; Perales M.-A.; De Colella J.M.S.; Blaise D.; Herrera A.F.; Shouse G.; Spilleboudt C.; Ansell S.M.; Nieto Y.; Badar T.; Hamadani M.; Feldman T.A.; Dahncke L.; Singh A.K.; McGuirk J.P.; Nishihori T.; Chavez J.; Serritella A.V.; Kline J.; Mohty M.; Dulery R.; Stamatoulas A.; Houot R.; Manson G.; Moles-Moreau M.-P.; Orvain C.; Bouabdallah K.; Modi D.; Ramchandren R.; Lekakis L.; Beitinjaneh A.; Frigault M.J.; Chen Y.-B.; Lynch R.C.; Smith S.D.; Rao U.; Byrne M.; Romancik J.T.; Cohen J.B.; Nathan S.; Phillips T.; Joyce R.M.; Rahimian M.; Bashey A.; Ballard H.J.; Svoboda J.; Torri V.; Sollini M.; De Philippis C.; Magagnoli M.; Santoro A.; Armand P.; Zinzani P.L.; Carlo-Stella C.. - In: LEUKEMIA. - ISSN 0887-6924. - ELETTRONICO. - -:(2021), pp. 1-12. [10.1038/s41375-021-01193-6]
Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma
Casadei B.;Zinzani P. L.;
2021
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
