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Publications

Journal Article Multicenter Study Ppublish

PubMed: 40623049 DOI: 10.1182/blood.2024027197

Outcomes of allogeneic HCT in Hodgkin lymphoma in the era of checkpoint inhibitors: a joint CIBMTR and EBMT analysis.

Blood 146(8):1011-1029

Authors: Miguel-Angel Perales, Farrukh T Awan, Ariane Boumendil, Jinalben Patel, Luca Castagna, Emanuele Angelucci, Herve Finel, Alexander Kulagin, Bertram Glass, Paolo Corradini, Alex F Herrera, Didier Blaise, Mohamed A Kharfan-Dabaja, Khalid Halahleh, Sairah Ahmed, Carmen Martínez, Sebastian Giebel, Silvia Montoto, Richard J Jones, Nausheen Ahmed, Ryan C Lynch, Marcos J De Lima, Mazyar Shadman, Craig S Sauter, Kwang W Ahn, Mehdi Hamadani, Ali Bazarbachi, Anna Sureda

Affiliations

  • Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Department of Medicine, Weill Cornell Medical College, New York, NY.
  • Division of Hematology and Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX.
  • European Society for Blood and Marrow Transplantation Lymphoma Working Party, Paris, France.
  • Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI.
  • Bone Marrow Transplantation Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy.
  • Unità Operativa Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
  • RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia.
  • Hämatologie und Zelltherapie, Helios Klinikum Berlin-Buch, Berlin, Germany.
  • Department of Pathophysiology and Transplantation, Istituto Nazionale dei Tumori, Milan, Italy.
  • Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope National Medical Center, Duarte, CA.
  • Transplant and Cellular Immunotherapy Program, Department of Hematology, Institute Paoli Calmettes, Management Sport Cancer Lab, Aix Marseille University, Marseille, France.
  • Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapy Program, Mayo Clinic, Jacksonville, FL.
  • Adult Bone Marrow Transplantation Program, Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
  • Departments of Lymphoma and Myeloma, and Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX.
  • Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
  • Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
  • Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
  • Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD.
  • Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Medical Center, Westwood, KS.
  • Clinical Research Division, Fred Hutch Cancer Center and Medical Oncology Division, University of Washington, Seattle, WA.
  • Department of Hematology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH.
  • Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH.
  • Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI.
  • Bone Marrow Transplantation and Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
  • Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
  • Clinical Hematology Department, Institut Catala d'Oncologia-L'Hospitalet, Instituto de Investigación Biomédica de Bellvitge, Universitat de Barcelona, Barcelona, Spain.

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.

MeSH

Hematology, Hodgkin Disease, Lymphoma, Transplants