Checkpoint Inhibitors Prior to Autologous Stem Cell Transplantation for Relapsed/ Refractory Hodgkin Lymphoma

Abstract

Aim: To present the evolution of our patients treated with checkpoint inhibitors before high-dose chemotherapy and autologous stem cell transplantation (ASCT) and to compare the results with data from the literature. Material and methods: We evaluate 3 patients with relapsed/refractory Hodgkin’s Lymphoma, who failed to achieve complete remission after 2 or more lines of salvage chemotherapy and were treated with anti PD1 inhibitors as a bridging therapy to autologous stem cell transplant. To evaluate the treatment response, we used PET CT scan before and 100 days after ASCT. Results: In our study, heavily pre-treated and chemo-refractory patients had increased response rates to conditioning chemotherapy followed by ASCT given after exposure to immune-checkpoint inhibitors. All 3 patients remain in complete response at 14 months, 20 months and respectively 32 months of follow-up. Conclusions: High-dose chemotherapy and ASCT can be curative for many patients with relapsed or refractory Hodgkin’s Lymphoma (HL), but the outcome depends on disease status at ASCT. Patients who have chemorefractory disease, particularly those who fail more than 2 lines of salvage therapy, are considered poor candidates for ASCT. Checkpoint inhibitors are routinely employed in relapsed/refractory classical Hodgkin lymphoma. The results from our center are similar with those from several studies which have suggested that treatment with anti PD1 can sensitize previously chemorefractory HL patients to subsequent high-dose therapy and ASCT.