Can immunotherapy before stem cell transplant improve results for patients with Hodgkin lymphoma?

This study examined the effectiveness and safety of immunotherapy before stem cell transplantation (SCT) in patients with Hodgkin lymphoma (HL). The authors concluded that this therapy increased the time before HL worsened and did not increase side effects.

Immunotherapy, including anti-PD-1 treatment such as nivolumab (Opdivo), has improved treatment results for patients with Hodgkin lymphoma (HL). However, it increases the risk of transplant failure in patients who previously received stem cell transplants (SCT). Transplant failure is where the transplanted cells fight to destroy the healthy cells of the patients. This is also known as graft-versus-host disease (GVHD). 

Often patients are given treatment such as chemotherapy drug cyclophosphamide (Cytoxan) to reduce the risk of transplant failure. It is unclear, however, if immunotherapy could be used safely before SCT and cyclophosphamide to improve treatment results.

59 patients with classical HL were divided into two groups. 29 patients received immunotherapy before SCT and cyclophosphamide (IT group). 30 patients only received SCT and cyclophosphamide (no-IT group). Patients were followed for an average of 26 months.

The IT group had a 77% higher chance of surviving without HL worsening than the no-IT group. After 2 years, 78% of the IT group and 53% of the no-IT group had not experienced cancer worsening. After 2 years, 4% of the IT group and 22% of the no-IT group had a return of HL (relapse) or HL worsening.

While the IT group had a 48% higher chance of surviving, this was not considered significant. After 2 years, 77% of the IT group and 71% of the no-IT group had survived.   

100 days after SCT, 41% of the IT group and 33% of the no-IT group developed transplant failure. 1 year after SCT, 7% of the IT group and 8% of the no-IT group still had transplant failure. 3 patients in the IT group developed a fever and 1 patient experienced immune system overactivation. No patients in the no-IT group developed fever or immune system overactivation.

The authors concluded that immunotherapy safely increased the time before HL worsened when given to patients before SCT and cyclophosphamide.

The small number of patients in the trial may have limited results. The study used data from medical records, meaning that some information was not available such as the type of immunotherapy used.