Long-term efficacy of anti-PD1 therapy in Hodgkin lymphoma with and without allogenic stem cell transplantation

• Published in: European journal of cancer (1990) Vol. 115; pp. 47 - 56
• Main Authors: Manson, Guillaume, Mear, Jean-Baptiste, Herbaux, Charles, Schiano, Jean-Marc, Casasnovas, Olivier, Stamatoullas, Aspasia, Deau, Bénédicte, Schmitt, Anna, Garnier, Georges, Regny, Caroline, Bouabdallah, Krimo, Moles-Moreau, Marie-Pierre, Ghesquieres, Hervé, Tempescul, Adrian, Dulery, Remy, Nicolas-Virelizier, Emmanuelle, Delmer, Alain, Borel, Cecile, Chauchet, Adrien, Damotte, Diane, Dercle, Laurent, Brice, Pauline, Houot, Roch
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2019; Elsevier Science Ltd; Elsevier
• Subjects: Allogenic haematopoietic stem cell transplantation; Anti-PD1; Checkpoint inhibitors; Consolidation; Hematopoietic stem cells; Hodgkin lymphoma; Hodgkin's lymphoma; Immunotherapy; Life Sciences; Lymphoma; Monoclonal antibodies; Nivolumab; PD-1 protein; Stem cell transplantation; Stem cells; Survival; Targeted cancer therapy; Therapy; Transplantation; Checkpoint inhibitors; Anti-PD1; Allogenic haematopoietic stem cell transplantation; Immunotherapy; Nivolumab; Hodgkin lymphoma
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2019.04.006

Long-term efficacy of anti-PD1 therapy and the need for a consolidation with allogenic haematopoietic stem cell transplantation (allo-HSCT) remain unclear in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). We retrospectively analysed 78 patients with R/R HL treated with nivolumab in the French Early Access Program and compared their outcomes according to subsequent allo-HSCT. After a median follow-up of 34.3 months, the best overall response rate was 65.8%, including 38.2% complete responses (CRs). The median progression-free survival (PFS) was 12.1 months. Patients reaching a CR upon nivolumab had a significantly longer PFS than those reaching a partial response (PR) (median = not reached vs 9.3 months, p < 0.001). In our cohort, 13 patients who responded (i.e. in CR or PR) to nivolumab monotherapy underwent consolidation with allo-HSCT. Among responding patients, none of those who underwent subsequent allo-HSCT (N = 13) relapsed, whereas 62.2% of those who were not consolidated with allo-HSCT (N = 37) relapsed (p < 0.001). There was no difference in overall survival (OS) between the two groups. Five of 6 patients who were not in CR at the time of transplantation (4 PRs and 1 progressive disease) converted into a CR after allo-HSCT. Most patients with R/R HL treated with anti-PD1 monotherapy eventually progressed, notably those who did not achieve a CR. Patients undergoing consolidation with allo-HSCT after anti-PD1 therapy experienced prolonged disease-free survival compared with non-transplanted patients, but this difference did not translate into a benefit in OS. This information should be considered when evaluating the risk/benefit ratio of allo-HSCT after anti-PD1 therapy. •Most patients with relapsed/refractory Hodgkin lymphoma eventually progressed during anti-programmed cell death-1 (anti-PD1) therapy.•In responding patients, the relapse rate was lower in patients consolidated with allogenic haematopoietic stem cell transplantation (allo-HSCT).•Among responders, subsequent allo-HSCT was not associated with a greater overall survival.