Guillaume Manson1, Jean-Baptiste Mear1, Charles Herbaux2, Jean-Marc Schiano3, Olivier Casasnovas4, Aspasia Stamatoullas5, Bénédicte Deau6, Anna Schmitt7, Georges Garnier8, Caroline Regny9, Krimo Bouabdallah10, Marie-Pierre Moles-Moreau11, Hervé Ghesquieres12, Adrian Tempescul13, Remy Dulery14, Emmanuelle Nicolas-Virelizier15, Alain Delmer16, Cecile Borel17, Adrien Chauchet18, Diane Damotte19, Laurent Dercle20, Pauline Brice21, Roch Houot22. 1. Department of Hematology, University Hospital of Rennes, Rennes, France. 2. Department of Hematology, University Hospital of Lille, Lille, France. 3. Department of Hematology, Paoli-Calmette Institute, Marseille, France. 4. Department of Hematology, University Hospital of Dijon, Dijon, France. 5. Department of Hematology, Centre Henri Becquerel, Rouen, France. 6. Department of Hematology, Cochin Hospital, AP-HP, Paris, France. 7. Department of Hematology, Bergonie Institute, Bordeaux, France. 8. Department of Medical Oncology, Princesse Grace Hospital, Monaco, Monaco. 9. Department of Hematology, University Hospital of Grenoble, Grenoble, France. 10. Department of Hematology, University Hospital of Bordeaux, Bordeaux, France. 11. Department of Hematology, University Hospital of Angers, Angers, France. 12. Department of Hematology, University Hospital of Lyon, Lyon, France. 13. Department of Hematology, University Hospital of Brest, Brest, France. 14. Department of Hematology, Saint-Antoine Hospital, AP-HP, Paris, France. 15. Department of Hematology, Leon Berard Center, Lyon, France. 16. Department of Hematology, University Hospital of Reims, Reims, France. 17. Department of Hematology, Institut Universitaire Du Cancer Toulouse-Oncopole, Toulouse, France. 18. Department of Hematology, University Hospital of Besançon, Besançon, France. 19. Laboratory "Immune Microenvironment and Tumors", Department "Cancer, Immunology, Immunotherapy", INSERM UMRS, 1138, Cordeliers Research Center, Paris, France. 20. Medical Imaging Department, Institut Gustave Roussy, Villejuif, France; UMR1015, Institut Gustave Roussy, Villejuif, France; Department of Radiology, Columbia University Medical Center, New York, NY, USA. 21. Department of Hematology, Saint-Louis Hospital, AP-HP, Paris, France. 22. Department of Hematology, University Hospital of Rennes, Rennes, France; INSERM, U1236, Rennes, France. Electronic address: roch.houot@chu-rennes.fr.
Abstract
INTRODUCTION: Long-term efficacy of anti-PD1 therapy and the need for a consolidation with allogenic haematopoietic stem cell transplantation (allo-HSCT) remain unclear in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). METHODS: We retrospectively analysed 78 patients with R/R HL treated with nivolumab in the French Early Access Program and compared their outcomes according to subsequent allo-HSCT. RESULTS: After a median follow-up of 34.3 months, the best overall response rate was 65.8%, including 38.2% complete responses (CRs). The median progression-free survival (PFS) was 12.1 months. Patients reaching a CR upon nivolumab had a significantly longer PFS than those reaching a partial response (PR) (median = not reached vs 9.3 months, p < 0.001). In our cohort, 13 patients who responded (i.e. in CR or PR) to nivolumab monotherapy underwent consolidation with allo-HSCT. Among responding patients, none of those who underwent subsequent allo-HSCT (N = 13) relapsed, whereas 62.2% of those who were not consolidated with allo-HSCT (N = 37) relapsed (p < 0.001). There was no difference in overall survival (OS) between the two groups. Five of 6 patients who were not in CR at the time of transplantation (4 PRs and 1 progressive disease) converted into a CR after allo-HSCT. CONCLUSION: Most patients with R/R HL treated with anti-PD1 monotherapy eventually progressed, notably those who did not achieve a CR. Patients undergoing consolidation with allo-HSCT after anti-PD1 therapy experienced prolonged disease-free survival compared with non-transplanted patients, but this difference did not translate into a benefit in OS. This information should be considered when evaluating the risk/benefit ratio of allo-HSCT after anti-PD1 therapy.
INTRODUCTION: Long-term efficacy of anti-PD1 therapy and the need for a consolidation with allogenic haematopoietic stem cell transplantation (allo-HSCT) remain unclear in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). METHODS: We retrospectively analysed 78 patients with R/R HL treated with nivolumab in the French Early Access Program and compared their outcomes according to subsequent allo-HSCT. RESULTS: After a median follow-up of 34.3 months, the best overall response rate was 65.8%, including 38.2% complete responses (CRs). The median progression-free survival (PFS) was 12.1 months. Patients reaching a CR upon nivolumab had a significantly longer PFS than those reaching a partial response (PR) (median = not reached vs 9.3 months, p < 0.001). In our cohort, 13 patients who responded (i.e. in CR or PR) to nivolumab monotherapy underwent consolidation with allo-HSCT. Among responding patients, none of those who underwent subsequent allo-HSCT (N = 13) relapsed, whereas 62.2% of those who were not consolidated with allo-HSCT (N = 37) relapsed (p < 0.001). There was no difference in overall survival (OS) between the two groups. Five of 6 patients who were not in CR at the time of transplantation (4 PRs and 1 progressive disease) converted into a CR after allo-HSCT. CONCLUSION: Most patients with R/R HL treated with anti-PD1 monotherapy eventually progressed, notably those who did not achieve a CR. Patients undergoing consolidation with allo-HSCT after anti-PD1 therapy experienced prolonged disease-free survival compared with non-transplanted patients, but this difference did not translate into a benefit in OS. This information should be considered when evaluating the risk/benefit ratio of allo-HSCT after anti-PD1 therapy.
Authors: Jesko Momotow; Helen Goergen; Karolin Behringer; Paul J Bröckelmann; Sven Borchmann; Bastian V Tresckow; Carsten Kobe; Andreas Engert; Stephanie Sasse Journal: Hemasphere Date: 2019-09-27