Background: Despite advances with immune checkpoint inhibitors (ICIs) in relapsed or refractory classical Hodgkin lymphoma (r/r cHL), many patients still require intensive consolidation. Combining ICIs with modern radiotherapy (RT) may provide a non-transplant salvage alternative.
Methods: We retrospectively analyzed patients with biopsy-proven r/r cHL treated at a single institution (2018–2024) who received ICIs (with or without chemotherapy) and modern RT (volumetric modulated arc therapy or tomotherapy), delivered concurrently or sequentially (interval ≤ 3 months). The treatment outcomes were analyzed according to clinical factors, and toxicities were displayed.
Results: Twenty-eight patients were included, and 64.3% had primary refractory disease and 78.6% relapsed after frontline ABVD. Ten patients (35.7%) received ICI monotherapy, while the remainder received ICI-based combinations. All patients completed modern RT. At a median follow-up of 36.5 months (range 4.1–75.4), the estimated 3-year progression-free survival (PFS) and overall survival (OS) rates were 79.6% and 100%, respectively. Six relapses (21.4%) occurred exclusively outside irradiated fields. PFS was significantly associated with stage IV disease and high GHSG score (both P<0.001). Treatment was well tolerated, with no grade ≥3 radiation-related adverse events.
Conclusion: ICIs combined with modern RT achieved high rates of durable disease control in selected patients with r/r cHL and may represent a viable non-transplant salvage strategy. Prospective studies are warranted to define optimal patient selection and integration with systemic therapy.
Yue Liu, Jingnan Wang, Yunpeng Wu, Xin Liu, Yongwen Song, Shu-Nan Qi, Ye-Xiong Li