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, Reid W; Castagna, Luca; Giordano, Laura; Ho, Vincent T; Corradini, Paolo; Guidetti, Anna; Casadei, Beatrice; Bond, David A; Jaglowski, Samantha; Spinner, Michael A; Arai, Sally; Lowsky, Robert; Shah, Gunjan L; Perales, Miguel-Angel; De Colella, Jean Marc Schiano; Blaise, Didier; Herrera, Alex F; Shouse, Geoffrey; Spilleboudt, Chloe; Ansell, Stephen M; Nieto, Yago; Badar, Talha; Hamadani, Mehdi; Feldman, Tatyana A; Dahncke, Lori; Singh, Anurag K; Mcguirk, Joseph P; Nishihori, Taiga; Chavez, Julio; Serritella, Anthony V; Kline, Justin; Mohty, Mohamad; Dulery, Remy; Stamatoulas, Aspasia; Houot, Roch; Manson, Guillaume; Moles-Moreau, Marie-Pierre; Orvain, Corentin; Bouabdallah, Kamal; Modi, Dipenkumar; Ramchandren, Radhakrishnan; Lekakis, Lazaros; Beitinjaneh, Amer; Frigault, Matthew J; Chen, Yi-Bin; Lynch, Ryan C; Smith, Stephen D; Rao, Uttam; Byrne, Michael; Romancik, Jason T; Cohen, Jonathon B; Nathan, Sunita; Phillips, Tycel; Joyce, Robin M; Rahimian, Maryam; Bashey, Asad; Ballard, Hatcher J; Svoboda, Jakub; Torri, Valter; Sollini, Martina; De Philippis, Chiara; Magagnoli, Massimo; Santoro, Armando; Armand, Philippe; Zinzani, Pier Luigi; Carlo-Stella, Carmelo. - In: LEUKEMIA. - ISSN 0887-6924. - 35:9(2021), pp. 2672-2683. [10.1038/s41375-021-01193-6]

Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma

Sollini, Martina;
2021-01-01

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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/149563
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