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 / R.W. Merryman, L. Castagna, L. Giordano, V.T. Ho, P. Corradini, A. Guidetti, B. Casadei, D.A. Bond, S. Jaglowski, M.A. Spinner, S. Arai, R. Lowsky, G.L. Shah, M.-. Perales, J.M.S. De Colella, D. Blaise, A.F. Herrera, G. Shouse, C. Spilleboudt, S.M. Ansell, Y. Nieto, T. Badar, M. Hamadani, T.A. Feldman, L. Dahncke, A.K. Singh, J.P. McGuirk, T. Nishihori, J. Chavez, A.V. Serritella, J. Kline, M. Mohty, R. Dulery, A. Stamatoulas, R. Houot, G. Manson, M.-. Moles-Moreau, C. Orvain, K. Bouabdallah, D. Modi, R. Ramchandren, L. Lekakis, A. Beitinjaneh, M.J. Frigault, Y.-. Chen, R.C. Lynch, S.D. Smith, U. Rao, M. Byrne, J.T. Romancik, J.B. Cohen, S. Nathan, T. Phillips, R.M. Joyce, M. Rahimian, A. Bashey, H.J. Ballard, J. Svoboda, V. Torri, M. Sollini, C. De Philippis, M. Magagnoli, A. Santoro, P. Armand, P.L. Zinzani, C. Carlo-Stella. - In: LEUKEMIA. - ISSN 0887-6924. - (2021 May 03). [Epub ahead of print]

Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma

L. Castagna;P. Corradini;A. Guidetti;C. De Philippis;
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.
Settore MED/15 - Malattie del Sangue
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/841522
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