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. 2020 Sep;26(9):1679-1688.
doi: 10.1016/j.bbmt.2020.06.012. Epub 2020 Jun 24.

Non-Myeloablative Allogeneic Transplantation with Post-Transplant Cyclophosphamide after Immune Checkpoint Inhibition for Classic Hodgkin Lymphoma: A Retrospective Cohort Study

Suman Paul  1 , Marianna Zahurak  1 , Leo Luznik  1 , Richard F Ambinder  1 , Ephraim J Fuchs  1 , Javier Bolaños-Meade  1 , Nina Wagner-Johnston  1 , Lode J Swinnen  1 , Laura Schoch  1 , Ravi Varadhan  1 , Richard J Jones  1 , Douglas E Gladstone  2
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Non-Myeloablative Allogeneic Transplantation with Post-Transplant Cyclophosphamide after Immune Checkpoint Inhibition for Classic Hodgkin Lymphoma: A Retrospective Cohort Study

Suman Paul et al. Biol Blood Marrow Transplant. 2020 Sep.

Abstract

: Immune checkpoint inhibitors (ICIs) are approved in relapsed classic Hodgkin lymphoma (cHL). The safety and effectiveness of allogeneic blood or marrow transplantation (alloBMT) in ICI-pretreated patients with cHL remain unclear. The aim of this study is to assess outcomes of patients with cHL receiving ICIs before alloBMT using post-transplantation cyclophosphamide (PTCy) graft-versus-host-disease (GVHD) prophylaxis. : We performed a retrospective study of relapsed/refractory patients with cHL undergoing alloBMT with PTCy at Johns Hopkins between November 2004 and September 2019. Engraftment, GVHD incidence, nonrelapse mortality, progression-free survival (PFS), and overall survival (OS) were compared between patients receiving pre-alloBMT ICI or standard salvage chemotherapy. : We identified 105 consecutive relapsed/refractory patients with cHL, of whom 37 (35.2%) received ICIs and 68 (64.7%) received chemotherapy without ICIs (no-ICI) before alloBMT. ICI and no-ICI patients experienced a 3-year estimated OS of 94% versus 78% (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.08 to 1.56; P = .17) and a 3-year estimated PFS of 90% and 65% (HR, 0.3; 95% CI, 0.09 to 1; P = .05), respectively. We observed no statically significant difference in the 12-month cumulative incidence of acute grade II to IV GVHD or in the 24-month incidence of chronic GVHD. : ICIs do not increase acute or chronic GVHD incidence compared with salvage chemotherapy. Patients with cHL receiving ICIs prior to alloBMT experienced outstanding PFS and OS. Thus, ICI therapy is safe in patients with cHL when undergoing alloBMT with PTCy and may improve post-alloBMT disease progression and survival.

Keywords: Allogeneic blood or marrow transplantation (alloBMT); Classic Hodgkin lymphoma (cHL); Engraftment; Graft-versus-host-disease (GVHD); Immune checkpoint Inhibitors (ICIs); Post-transplantation cyclophosphamide (PTCy).

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Conflict of interest statement

Conflict of interest statements

N.W.J participates in advisory boards of Regeneron, ADC Therapeutics, CALIBR, Versatem, Bayer, Gilead. J.B.M has received honoraria from Incyte Corporation as a member of their Data Monitoring Committee.

Ethics committee approval

Study was approved by Johns Hopkins Medicine Institutional Review Board.

Figures

Figure 1:
Figure 1:. Cumulative incidence of aGVHD (A) and cGVHD (B).
The curves were truncated at 12 months for aGVHD and 24 months for cGVHD. ICI=Immune Checkpoint Inhibitor.
Figure 2.
Figure 2.. Cumulative incidence of Relapse and NRM after alloBMT with PTCy.
ICI=Immune Checkpoint Inhibitor.
Figure 3.
Figure 3.. Kaplan-Meier curve for (A) PFS (B) OS in ICI or no-ICI pre-treated alloBMT patients.
The curves are truncated at 48 months. ICI=Immune Checkpoint Inhibitor.
Figure 4.
Figure 4.. Kaplan-Meier curve for (A) PFS (B) OS in post-2015 ICI or no-ICI pre-treated alloBMT patients.
The curves are truncated at 48 months. ICI=Immune Checkpoint Inhibitor.
Figure 5.
Figure 5.. Kaplan-Meier curve for (A) PFS (B) OS in BV or no BV pre-treated alloBMT patients.
The curves are truncated at 54 months. BV=Brentuximab vedotin.
See this image and copyright information in PMC

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