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. 2016 Nov 30;9(1):132.
doi: 10.1186/s13045-016-0363-1.

High rate of complete responses to immune checkpoint inhibitors in patients with relapsed or refractory Hodgkin lymphoma previously exposed to epigenetic therapy

Lorenzo Falchi  1 , Ahmed Sawas  1 , Changchun Deng  1 , Jennifer E Amengual  1 , Donald S Colbourn  1 , Emily A Lichtenstein  1 , Karen A Khan  1 , Lawrence H Schwartz  2 , Owen A O'Connor  3
Affiliations

High rate of complete responses to immune checkpoint inhibitors in patients with relapsed or refractory Hodgkin lymphoma previously exposed to epigenetic therapy

Lorenzo Falchi et al. J Hematol Oncol. .

Abstract

Options for patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL) after brentuximab vedotin (Bv) and autologous stem cell transplantation (ASCT) are limited. Immune checkpoint inhibitors (ICI) are active in this population but rarely induce complete response (CR). Ten patients with R/R cHL after ASCT and Bv received pembrolizumab (n = 8) or nivolumab (n = 2). Five had been previously exposed to 5-azacitidine on a phase 1 study. Among nine evaluable patients, seven (78%) achieved CR, one partial response, and one reduction of tumor burden. All five patients who had received 5-azacitidine prior to ICI achieved CR, while only two of four who did not receive prior 5-azacitidine achieved CR. At a median follow-up of 9.9 months [0.5-14.3], eight patients are alive and five are still receiving treatment. We documented an unprecedented CR rate after ICI in patients with R/R cHL. We hypothesize that hypomethylating agents might have an immune priming effect and enhance the efficacy of ICI.

Keywords: Azacitidine; Epigenetic therapy; Hodgkin lymphoma; Nivolumab; Pembrolizumab.

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Figures

Fig. 1
Fig. 1
Previous therapies and respective duration of disease control. For each patient, bar length and number represent the time to next treatment (in months). Section sign includes salvage chemotherapy followed by high-dose chemotherapy and ASCT; Asterisk indicates Bv induction followed by ASCT consolidation and Bv maintenance. Abbreviations: ICI immune checkpoint inhibitor, Bv brentuximab vedotin, ASCT autologous stem cell transplantation, AlloSCT allogeneic stem cell transplantation
Fig. 2
Fig. 2
Type of immune checkpoint inhibitor, treatment duration, dose intensity, and type and duration of response. For each patient, the bar length indicates the amount of time spent in a specific (color-coded) disease state. Abbreviations: AlloSCT allogeneic stem cell transplantation, MDS myelodysplastic syndrome, AML acute myeloid leukemia, CR complete response, ICI immune checkpoint inhibitor
See this image and copyright information in PMC

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