Autologous stem cell transplantation after anti-PD-1 therapy for multiply relapsed or refractory Hodgkin lymphoma

Reid W. Merryman, Robert A. Redd, Taiga Nishihori, Julio Chavez, Yago Nieto, Justin M. Darrah, Uttam Rao, Michael T. Byrne, David A. Bond, Kami J. Maddocks, Michael A. Spinner, Ranjana H. Advani, Hatcher J. Ballard, Jakub Svoboda, Anurag K. Singh, Joseph P. McGuirk, Dipenkumar Modi, Radhakrishnan Ramchandren, Jason Romancik, Jonathon B. CohenMatthew J. Frigault, Yi Bin Chen, Anthony V. Serritella, Justine Kline, Stephen Ansell, Sunita Nathan, Maryam Rahimian, Robin M. Joyce, Mansi Shah, Kevin A. David, Steven Park, Anne W. Beaven, Alma Habib, Veronika Bachanova, Shazia Nakhoda, Nadia Khan, Ryan C. Lynch, Stephen D. Smith, Vincent T. Ho, Ann LaCasce, Philippe Armand, Alex F. Herrera

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1648-1659
Number of pages12
JournalBlood Advances
Volume5
Issue number6
DOIs
StatePublished - Mar 23 2021

Bibliographical note

Publisher Copyright:
© 2021 by The American Society of Hematology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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