Outcomes of allogeneic HCT in Hodgkin lymphoma in the era of checkpoint inhibitors: a joint CIBMTR and EBMT analysis
Abstract
Abstract Checkpoint inhibitors (CPIs) have shown remarkable efficacy in Hodgkin lymphoma (HL), and are now used routinely. While allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative option for HL, there are concerns prior CPIs may exacerbate post–allo-HCT complications, particularly graft-versus-host disease (GVHD), and lead to worse outcomes. Given the relative paucity of data, we performed a Center for International Blood and Marrow Transplant Research/European Society for Blood and Marrow Transplantation study to examine the impact of prior CPIs in allo-HCT. We included 2186 adult patients aged >18 years who received a first allo-HCT using a matched related, unrelated, or haploidentical donor from 2008 to 2023. Twenty-seven percent of patients received prior CPIs. GVHD prophylaxis was posttransplant cyclophosphamide (PTCy) in 55.8% of patients in the CPI cohort, and 35% in the non-CPI cohort. Median follow-up among survivors was longer for the non-CPI (39 months) than CPI cohort (16.5 months). In multivariate analysis, prior CPI exposure did not affect overall survival (OS) or nonrelapse mortality, but resulted in improved progression-free survival (non-CPI vs CPI hazard ratio [HR], 0.81; 0.67-0.98; P = .03) and lower relapse incidence (HR, 0.58; 0.45-0.76; P < 001). While grade 2 to 4 (HR, 1.26; 1.04-1.53; P = .02) and 3 to 4 (HR, 1.41; 1.04-1.92; P = .03) acute GVHD (aGVHD) were increased, differences in chronic GVHD (cGVHD) were not significant. PTCy–based GVHD prophylaxis resulted in improved OS, lower grade 2 to 4 aGVHD, and cGVHD in patients with prior CPI exposure. In summary, allo-HCT should still be considered a curative option for patients with HL in the era of CPIs.
Article Details
Authors (28)
Miguel-Angel Perales
1Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY
Farrukh T. Awan
3Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
Ariane Boumendil
32Intergroupe Francophone du Myelome, Paris, France
Jinalben Patel
24Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, United States
Luca Castagna
12BMT unit, AOR Villa Sofia Cervello, Palermo, Italy, Palermo, Italy
Emanuele Angelucci
Herve Finel
4European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France
Alexander Kulagin
1RM Gorbacheva Research Institute, Saint Petersburg, Russian Federation
Bertram Glass
21Department of Hematology and Cell Therapy Helios Klinikum Berlin-Buch, Berlin, Germany
Paolo Corradini
8Istituto Nazionale Tumori IRCCS, Haematology, Milan, Italy
Alex F. Herrera
10Duarte Cancer Center, City of Hope Medical Center, Duarte, CA
Didier Blaise
19Programme de Transplantation & Therapie Cellulaire, Marseille, France
Mohamed A. Kharfan-Dabaja
Mayo Clinic, Jacksonville, Florida, United States
Khalid Halahleh
10Department of Internal Medicine, Adult BMT Program, King Hussein Cancer Center, Amman, Jordan
Sairah Ahmed
2Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
Carmen Martínez
Sebastian Giebel
Silvia Montoto
21Department of Haemato-Oncology, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
Richard J. Jones
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine
Nausheen Ahmed
5University of Kansas Health System, Division of Hematological Malignancy and Cellular Therapeutics, Kansas City, United States
Ryan C. Lynch
Marcos J. de Lima
1Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
Mazyar Shadman
Craig S. Sauter
23Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
Kwang W. Ahn
5Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
Mehdi Hamadani
12Blood and Marrow Transplant and Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
Ali Bazarbachi
21Hematology-Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Anna Sureda
Institut Català d'Oncologia, Barcelona, Spain