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Merryman RW , Redd RA , Nishihori T , Chavez J , Nieto Y , Darrah JM , Rao U , Byrne MT , Bond DA , Maddocks KJ , Spinner MA , Advani RH , Ballard HJ , Svoboda J , Singh AK , McGuirk JP , Modi D , Ramchandren R , Romancik J , Cohen JB , Frigault MJ , Chen YB , Serritella AV , Kline J , Ansell S , Nathan S , Rahimian M , Joyce RM , Shah M , David KA , Park S , Beaven AW , Habib A , Bachanova V , Nakhoda S , Khan N , Lynch RC , Smith SD , Ho VT , LaCasce A , Armand P , Herrera AF
Autologous stem cell transplantation after anti-PD-1 therapy for multiply relapsed or refractory Hodgkin lymphoma
Blood Adv. 2021 Mar 23;5(6) :1648-1659
PMID: 33710337    PMCID: PMC7993097     URL: https://www.ncbi.nlm.nih.gov/pubmed/33710337
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Abstract
Autologous stem cell transplantation (ASCT) can be curative for patients with relapsed/refractory Hodgkin lymphoma (HL). Based on studies suggesting that anti-PD-1 monoclonal antibodies (mAbs) can sensitize patients to subsequent chemotherapy, we hypothesized that anti-PD-1 therapy before ASCT would result in acceptable outcomes among high-risk patients who progressed on or responded insufficiently to ≥1 salvage regimen, including chemorefractory patients who are traditionally considered poor ASCT candidates. We retrospectively identified 78 HL patients who underwent ASCT after receiving an anti-PD-1 mAb (alone or in combination) as third-line or later therapy across 22 centers. Chemorefractory disease was common, including 42 patients (54%) refractory to ≥2 consecutive systemic therapies immediately before anti-PD-1 treatment. Fifty-eight (74%) patients underwent ASCT after anti-PD-1 treatment, while 20 patients (26%) received additional therapy after PD-1 blockade and before ASCT. Patients received a median of 4 systemic therapies (range, 3-7) before ASCT, and 31 patients (41%) had a positive pre-ASCT positron emission tomography (PET) result. After a median post-ASCT follow-up of 19.6 months, the 18-month progression-free survival (PFS) and overall survival were 81% (95% CI, 69-89) and 96% (95% confidence interval [CI], 87-99), respectively. Favorable outcomes were observed for patients who were refractory to 2 consecutive therapies immediately before PD-1 blockade (18-month PFS, 78%), had a positive pre-ASCT PET (18-month PFS, 75%), or received ≥4 systemic therapies before ASCT (18-month PFS, 73%), while PD-1 nonresponders had inferior outcomes (18-month PFS, 51%). In this high-risk cohort, ASCT after anti-PD-1 therapy was associated with excellent outcomes, even among heavily pretreated, previously chemorefractory patients.
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2473-9537 Merryman, Reid W Redd, Robert A Nishihori, Taiga Chavez, Julio Nieto, Yago Darrah, Justin M Rao, Uttam Byrne, Michael T Bond, David A Maddocks, Kami J Spinner, Michael A Advani, Ranjana H Ballard, Hatcher J Svoboda, Jakub Singh, Anurag K McGuirk, Joseph P Modi, Dipenkumar Ramchandren, Radhakrishnan Romancik, Jason Cohen, Jonathon B Frigault, Matthew J Chen, Yi-Bin Serritella, Anthony V Kline, Justine Ansell, Stephen Nathan, Sunita Rahimian, Maryam Joyce, Robin M Shah, Mansi David, Kevin A Park, Steven Beaven, Anne W Habib, Alma Bachanova, Veronika Nakhoda, Shazia Khan, Nadia Lynch, Ryan C Smith, Stephen D Ho, Vincent T LaCasce, Ann Armand, Philippe Herrera, Alex F Journal Article Blood Adv. 2021 Mar 23;5(6):1648-1659. doi: 10.1182/bloodadvances.2020003556.