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Merryman RW, Castagna L, Giordano L, Ho VT, Corradini P, Guidetti A, Casadei B, Bond DA, Jaglowski S, Spinner MA, Arai S, Lowsky R, Shah GL, Perales MA, De Colella JMS, Blaise D, Herrera AF, Shouse G, Spilleboudt C, Ansell SM, Nieto Y, Badar T, Hamadani M, Feldman TA, Dahncke L, Singh AK, McGuirk JP, Nishihori T, Chavez J, Serritella AV, Kline J, Mohty M, Dulery R, Stamatoulas A, Houot R, Manson G, Moles-Moreau MP, Orvain C, Bouabdallah K, Modi D, Ramchandren R, Lekakis L, Beitinjaneh A, Frigault MJ, Chen YB, Lynch RC, Smith SD, Rao U, Byrne M, Romancik JT, Cohen JB, Nathan S, Phillips T, Joyce RM, Rahimian M, Bashey A, Ballard HJ, Svoboda J, Torri V, Sollini M, De Philippis C, Magagnoli M, Santoro A, Armand P, Zinzani PL, Carlo-Stella C. Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma. Leukemia 2021; 35:2672-2683. [PMID: 33658659 DOI: 10.1038/s41375-021-01193-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Anti-PD-1 monoclonal antibodies yield high response rates in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but most patients will eventually progress. Allogeneic hematopoietic cell transplantation (alloHCT) after PD-1 blockade may be associated with increased toxicity, raising challenging questions about the role, timing, and optimal method of transplantation in this setting. To address these questions, we assembled a retrospective cohort of 209 cHL patients who underwent alloHCT after PD-1 blockade. With a median follow-up among survivors of 24 months, the 2-year cumulative incidences (CIs) of non-relapse mortality and relapse were 14 and 18%, respectively; the 2-year graft-versus-host disease (GVHD) and relapse-free survival (GRFS), progression-free survival (PFS), and overall survival were 47%, 69%, and 82%, respectively. The 180-day CI of grade 3-4 acute GVHD was 15%, while the 2-year CI of chronic GVHD was 34%. In multivariable analyses, a longer interval from PD-1 to alloHCT was associated with less frequent severe acute GVHD, while additional treatment between PD-1 and alloHCT was associated with a higher risk of relapse. Notably, post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis was associated with significant improvements in PFS and GRFS. While awaiting prospective clinical trials, PTCy-based GVHD prophylaxis may be considered the optimal transplantation strategy for this patient population.
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Affiliation(s)
- Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Luca Castagna
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Laura Giordano
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Beatrice Casadei
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
| | - David A Bond
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Michael A Spinner
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Sally Arai
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Robert Lowsky
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean Marc Schiano De Colella
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Didier Blaise
- Institut Paoli-Calmettes, Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Geoffrey Shouse
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | | | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Talha Badar
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tatyana A Feldman
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Lori Dahncke
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Anurag K Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Joseph P McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Julio Chavez
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Anthony V Serritella
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hospital Saint Antoine, Sorbonne University, Paris, France
| | - Remy Dulery
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Roch Houot
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | - Guillaume Manson
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | | | | | | | - Dipenkumar Modi
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | | | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Matthew J Frigault
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan C Lynch
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Uttam Rao
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Tycel Phillips
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Robin M Joyce
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maryam Rahimian
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Hatcher J Ballard
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Valter Torri
- Laboratory of Methodology of Clinical Research, Oncology Department. IRCCS Mario Negri Institute, Milano, Italy
| | - Martina Sollini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Chiara De Philippis
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Armando Santoro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pier Luigi Zinzani
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Carmelo Carlo-Stella
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
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