PD-1 Blockade Pre-Transplant Improves Outcomes in Hodgkin Lymphoma

I'm Dr. Sanjal Desai, Assistant Professor in the Division of Hematology, Oncology, and Transplantation at University of Minnesota. I'm a clinical investigator with principal focus on aggressive B-cell lymphoma and Hodgkin lymphoma. At ASH 2023, I presented results of our collaborative multi-center retrospective study where we looked at outcomes of relapsed refractory classic Hodgkin lymphoma patients who undergo autologous stem cell transplant. These are the patients of Hodgkin lymphoma who get their disease back after receiving their first line of treatment, which is usually either a chemoimmunotherapy or chemotherapy regimen. Standard of care option for these patients is receiving more high dose chemotherapy and then if they respond to that they go for some autologous stem cell transplant consolidation. Recently multiple clinical trials have shown that new medications, novel regimens, as salvage therapy regimens such as regimens containing PD-1 inhibitors or a regimen containing brentuximab and abidotin have encouraging response rates and survival in patients of relapsed Hodgkin lymphoma who go for autologous stem cell transplant. However, we do not have any randomized trials yet comparing these novel or new regimens to conventional chemotherapy based regimens that we have been using for years. In collaboration with five academic institutions in the United States, we generated a data set, a retrospective study of patients of relapsed refractory Hodgkin lymphoma and we looked at outcomes of patients who receive new regimens such as PD-1 blocker based regimen or brentuximab abidotin based regimen and compared the outcomes to patients who received chemotherapy based salvage regimen before transplant. And we saw that patients who received new regimens such as PD-1 inhibitor based regimen or brentuximab abidotin based regimen had lower likelihood of progression after transplant, which means that these patients had lower likelihood of their Hodgkin lymphoma coming back after going through transplant. These results were only true for patients who received PD-1 inhibitor either with brentuximab abidotin or PD-1 inhibitor with chemotherapy. Patients who received only brentuximab abidotin without PD-1 inhibitors had very similar outcomes to patients who would receive chemotherapy. So we found that PD-1 inhibitor based regimen before transplant will reduce likelihood of relapse after transplant, which means that it reduces likelihood of the Hodgkin lymphoma coming back after autologous stem cell transplant.