A RECENT study highlights the benefits of using immune checkpoint inhibitors (ICIs) before allogeneic blood or marrow transplantation (alloBMT) for patients with relapsed classic Hodgkin lymphoma (cHL). According to a retrospective analysis of 147 patients, those who received ICIs prior to alloBMT showed significant improvements in overall survival (OS) and progression-free survival (PFS) compared to those treated with chemotherapy alone.
Among the 147 relapsed/refractory patients with cHL, 71 (48.3%) received ICIs and 76 (51.7%) received chemotherapy without ICIs (no-ICI) before alloBMT. The 5-year estimated OS was 91% for patients treated with ICIs, versus 66% for those receiving chemotherapy (hazard ratio [HR]: 0.39; 95% confidence interval [CI]: 0.16–0.98; P=0.046). Similarly, the 5-year PFS for the ICI group was 84%, while the chemotherapy-only group had 53% (HR: 0.4; 95% CI: 0.2–0.81; P=0.011).
However, the study also observed a higher risk of severe acute graft-versus-host disease (GVHD) in patients who received ICIs before transplantation. The 12-month cumulative incidence of grade III-IV acute GVHD was 20% in the ICI group compared to 7% in the chemotherapy group (SDHR 3.16, CI: 1.13–8.81; P=0.03). The researchers suggest that this increased risk may be managed by enhancing immunosuppression following transplantation, particularly extending it up to 180 days.
This study highlights the potential of ICIs to improve long-term survival outcomes for relapsed cHL patients undergoing alloBMT, while also providing insight into managing the associated risks of acute GVHD with tailored immunosuppression strategies.
Helena Bradbury, EMJ
Reference
Tabbara N et al. Improved overall survival with checkpoint inhibition and allogeneic transplantation in relapsed hodgkin lymphoma. Blood Adv. 2024; doi: 10.1182/bloodadvances.2024015048.
