Benefits of autologous hematopoietic stem cell transplantation after checkpoint inhibitor therapy in patients with relapsed/refractory Hodgkin lymphoma

The study evaluated real-life benefits of autologous hematopoietic stem cell transplantation (ASCT) after immune checkpoint inhibitor (CPi) therapy in patients with relapsed/refractory (r/r) Hodgkin lymphoma (HL). The authors found that ASCT can be an effective option after CPi therapy in such patients.

Some patients with r/r-HL experience cancer return after previous therapies or fail to respond to treatment. They are generally prescribed CPis such as nivolumab (Opdivo) and pembrolizumab (Keytruda). CPis are immunotherapy drugs that improve the immune system response to detect and fight cancer.

Patients whose r/r-HL returns after CPi treatments can receive allogeneic transplants (alloSCT) which use bone marrow from donors. AlloSCT has several risks and toxicities. ASCT uses patients’ own stem cells. It is unknown whether ASCT after CPi therapy is safe and effective for these patients in real life.

The study analyzed the medical records of 13 adult patients with r/r-HL. They had received for the first time ASCT as consolidation. Consolidation therapy is used to kill cancer cells that may be left in the body after previous treatment. Patients received an average of 3 prior therapies before ASCT, including CPis (nivolumab or pembrolizumab). Patients were followed up for 3.3 years on average.

After CPi therapy, 5 patients achieved a complete response (CR), 5 had a partial response (PR) and 3 patients had cancer progression. CR means the absence of all cancer symptoms and PR refers to a partial disappearance of cancer.

11 patients achieved a CR following ASCT. The overall response rate (ORR) was 84.6%. 1 patient with CR relapsed after 3.9 months of ASCT.

Disease-free survival (DFS) defines the time between the first occurrence of CR and the date of relapse. 87.5% of patients had DFS after 56.9 months. 73.4% of patients were estimated to survive for 5 years without cancer progression. Overall, 92.3% of patients were estimated to be alive after 4.8 years.

The study concluded that ASCT can be a further effective consolidation treatment in patients with r/r-HL after CPi therapy, in real-world medical practice.

This study looked back in time to analyze 13 patients’ data from one hospital in Italy only. Larger studies may be performed to further support ASCT’s benefit in real-life.