ISHL10 Abstract P102

A role for allogeneic stem cell transplantation in the era of novel agents for Hodgkin's lymphoma?

Patients with relapsed Hodgkins lymphoma (HL) can achieve long term remission after high-dose chemotherapy and autologous stem cell transplantation (SCT). However the prognosis is dismal for patients relapsing after autologous SCT. The advent of novel agents such as brentuximab vedotin or checkpoint-inhibitors has enabled a large proportion of patients to achieve responses, but these remissions are often not durable. On the other hand there have been several attempts to use allogeneic SCT as a potentially curative treatment modality in HL. While progress has been made to reduce the transplant-related mortality, relapse after transplant remains the biggest challenge for allogeneic SCT. In order to investigate how the availability of novel agents may have influenced the results of allogeneic SCT we performed a retrospective single centre analysis in our institution. Thirty seven patients with relapsed/refractory HL were transplanted between 2005 and 2016. Median overall survival (OS) after transplant was 4.4 years with 57% OS at 3 years. There was no difference in OS in patients transplanted before or after 2010. Remission status before allogeneic SCT had a significant impact on 3 yr OS which was 75% in patients transplanted in CR, 63% in PR, 66% in SD and 22% in patients with progressive disease. Of the 20 patients in CR or PR before transplant 2 (10%) died from transplant-related causes. Eight patients (40%) in this group relapsed after transplant. While four patients eventually died from relapsed HL, four patients are long term survivors 5 – 6.6 years from transplant after being treated with novel agents such as brentuximab, everolimus or ruxolitinib. In the era of novel agents performing allogeneic SCT in patients with relapsed HL at the time of maximum response may provide long term survival with acceptable transplant-related risks. In addition using these agents to treat relapse after transplant can further improve the long term prognosis. While more and more options are available to optimize the remission status before transplant, new approaches will incorporate novel agents in the early post-transplant phase before day 100, such as everolimus in our current single-centre OCTET-Ever protocol or brentuximab vedotin in a planned multi-centre protocol by the German Hodgkin Study Group.

Authors

  • C. Scheid
  • J. Chemnitz
  • M. Herling
  • N. Pflug
  • S. Theurich
  • A. Burst
  • S. Leitzke
  • Bergwelt-Baildon M. von
  • M. Hallek
  • U. Holtick