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Autologous stem cell transplantation after anti-PD-1 therapy for multiply relapsed or refractory Hodgkin lymphoma. 2021
Reid W Merryman, and
Robert A Redd, and
Taiga Nishihori, and
Julio Chavez, and
Yago Nieto, and
Justin M Darrah, and
Uttam Rao, and
Michael T Byrne, and
David A Bond, and
Kami J Maddocks, and
Michael A Spinner, and
Ranjana H Advani, and
Hatcher J Ballard, and
Jakub Svoboda, and
Anurag K Singh, and
Joseph P McGuirk, and
Dipenkumar Modi, and
Radhakrishnan Ramchandren, and
Jason Romancik, and
Jonathon B Cohen, and
Matthew J Frigault, and
Yi-Bin Chen, and
Anthony V Serritella, and
Justine Kline, and
Stephen Ansell, and
Sunita Nathan, and
Maryam Rahimian, and
Robin M Joyce, and
Mansi Shah, and
Kevin A David, and
Steven Park, and
Anne W Beaven, and
Alma Habib, and
Veronika Bachanova, and
Shazia Nakhoda, and
Nadia Khan, and
Ryan C Lynch, and
Stephen D Smith, and
Vincent T Ho, and
Ann LaCasce, and
Philippe Armand, and
Alex F Herrera
Division of Hematologic Malignancies and.
Autologous stem cell transplantation (ASCT) can be curative for patients with relapsed/refractory Hodgkin lymphoma (HL). Based on studies suggesting that anti-PD-1 monoclonal antibodies (mAbs) can sensitize patients to subsequent chemotherapy, we hypothesized that anti-PD-1 therapy before ASCT would result in acceptable outcomes among high-risk patients who progressed on or responded insufficiently to ≥1 salvage regimen, including chemorefractory patients who are traditionally considered poor ASCT candidates. We retrospectively identified 78 HL patients who underwent ASCT after receiving an anti-PD-1 mAb (alone or in combination) as third-line or later therapy across 22 centers. Chemorefractory disease was common, including 42 patients (54%) refractory to ≥2 consecutive systemic therapies immediately before anti-PD-1 treatment. Fifty-eight (74%) patients underwent ASCT after anti-PD-1 treatment, while 20 patients (26%) received additional therapy after PD-1 blockade and before ASCT. Patients received a median of 4 systemic therapies (range, 3-7) before ASCT, and 31 patients (41%) had a positive pre-ASCT positron emission tomography (PET) result. After a median post-ASCT follow-up of 19.6 months, the 18-month progression-free survival (PFS) and overall survival were 81% (95% CI, 69-89) and 96% (95% confidence interval [CI], 87-99), respectively. Favorable outcomes were observed for patients who were refractory to 2 consecutive therapies immediately before PD-1 blockade (18-month PFS, 78%), had a positive pre-ASCT PET (18-month PFS, 75%), or received ≥4 systemic therapies before ASCT (18-month PFS, 73%), while PD-1 nonresponders had inferior outcomes (18-month PFS, 51%). In this high-risk cohort, ASCT after anti-PD-1 therapy was associated with excellent outcomes, even among heavily pretreated, previously chemorefractory patients.
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