Have outcomes improved for patients with Hodgkin’s lymphoma who relapse after a stem cell transplant?

This study evaluated the long-term outcomes of patients with classical Hodgkin’s lymphoma (cHL) that came back after an autologous stem cell transplant (autoSCT). This study found that advancements in treatment have helped improve survival outcomes for patients.

Chemotherapy is usually the first-line treatment of choice for patients with cHL. For patients whose cancer relapses (returns), autoSCT is the standard of care. This type of SCT uses a patient’s stem cells to replace cancer cells with healthy cells. cHL that comes back after autoSCT can be challenging to treat.

Several therapies have become more common in treating relapsed cHL. One option is allogeneic SCT, which uses stem cells from a healthy donor. Targeted therapy is also used. Brentuximab vedotin (BV) uses antibodies to deliver chemotherapy only to cancer cells. Checkpoint inhibitors, such as pembrolizumab (Keytruda), help the immune system recognize and fight cancer cells. It is unclear how these treatments have changed outcomes for patients who relapse after autoSCT.

This study involved 215 patients with cHL that relapsed after autoSCT. Patients were divided into two groups. 118 patients (Group A) experienced relapse between 2005 and 2010. 97 patients (Group B) experienced relapse between 2010 and 2016.

Among patients who relapsed within a year of autoSCT, fewer patients were still alive 5 years later compared to patients who relapsed later (32% vs. 57%). Patients in Group B had a 41% longer survival without relapse after autoSCT compared to Group A.

After relapse, patients had an average of 2 lines of therapy after autoHCT. More patients in Group B received BV (69%) or checkpoint inhibitors (36%) compared to patients in Group A (55%, BV and 3%, inhibitors).

Overall, 27% of all patients underwent alloHCT. More patients in Group B had alloSCT compared to Group A (35% vs. 22%). On average, patients survived for 14.2 months without the cancer getting worse.

Overall, 38% of all patients were still alive 5 years later. Significantly more patients in Group B were still alive 5 years later compared to Group A (50% vs. 32%).

This study found that advancements in treatment have helped improve survival outcomes for patients. The authors suggest that this may be due to more treatment options and increased use of alloHCT.

This study included a small number of patients and looked back in time to analyze data. More studies are needed.