Background: In the past years, PD-1 blockade for relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL) has increased in clinical practice, both as salvage therapy prior to autologous stem-cell transplantation (ASCT) and for patients (pts) who are ineligible or have relapsed after ASCT. The aim here was to describe the clinical outcome with the PD-1 inhibitors nivolumab and pembrolizumab in a cohort of consecutive pts with R/R cHL.
Methods: Clinical data from pts with cHL treated with anti-PD-1 therapy at the Hematology Dept. at Karolinska University Hospital during the years of 2017-2023 was gathered from medical records. Considering that clinical benefit was often achieved despite radiological progression, time to next treatment or death (TTNT-D) was used as a marker of clinical outcome whilst overall response rate (ORR) was calculated based on best objective radiological response.
Results: Thirty pts with R/R cHL who received ≥1 dose of either nivolumab or pembrolizumab were included. Median age at start of treatment was 48.5 years (range 18-89) and 67% of the pts were men. Two groups were considered for further analysis: Group 1 (n=15) received anti-PD-1 alone or in combination with chemotherapy with the intention to proceed to ASCT and Group 2 (n=15) were ineligible for or had progressed after ASCT. In Group 1, ORR was 93%; 10 CR and 2 PR before proceeding to ASCT, 2 achieved CR but were later deemed ineligible for ASCT and 1 died due to PD. At a median follow-up of 28 months (range 3-71), 87% remain in CR and the estimated OS and proportion of pts with remaining clinical benefit at 2 years were both 93% (Fig. A and B). Group 2 showed an ORR of 67% (5 CR and 5 PR). At a median follow-up of 24 months (range 4-92), 3 are treatment-free in CR, 2 pts died due to PD and 1 died due to complications following allogeneic SCT. Among the pts still in CR, 2 were treated with concomitant RT and 1 received additional treatment following relapse. At 2 years, the estimated OS and proportion of pts with remaining clinical benefit was 72% and 52%, respectively (Fig. A and B). At the end of the study period, 5 pts remain on treatment. Excluding planned discontinuations, the main causes for discontinuation were PD in 5 pts (17%) and adverse events in 3 (10%).
Conclusion: We conclude that anti-PD-1 therapy is an effective and well tolerated treatment for R/R cHL as well as an effective addition to salvage chemotherapy preceding ASCT in a real-world setting.
Zaid Mansur, Elin Lundin, Lotta Hansson, Björn Engelbrekt Wahlin, Marzia Palma