Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) after Treatment with Nivolumab for Relapsed/Refractory Hodgkin Lymphoma

• Published in: Blood 2016-12, Vol.128 (22), p.3502-3502
• Main Authors: Armand, Philippe, Zinzani, Pier Luigi, Collins, Graham P., Cohen, Jonathon B., Halwani, Ahmad S., Carlo-Stella, Carmelo, Millenson, Michael M., Provencio, Mariano, Domingo Domenech, Eva, Giulino Roth, Lisa, Castagna, Luca, Kato, Kazunobu, Popa McKiver, Mihaela, Sumbul, Anne, Zhu, Lili, Santoro, Armando
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V128.22.3502.3502

Introduction: Allo-HSCT is a potentially curative option for patients (pts) with classical Hodgkin lymphoma (cHL) who relapse after autologous (auto)-HSCT. Nivolumab (nivo) is approved in the US for treatment of relapsed or progressive cHL after auto-HSCT and post-transplant brentuximab vedotin. Nivo was studied in pts with relapsed cHL in ph 1 (CheckMate 039, NCT01592370) and multicohort ph 2 (CheckMate 205, NCT02181738) studies. Response rate in 95 heavily pretreated cHL pts across those studies was 65%, with an estimated median duration of response of 8.7 mo. Decision to proceed to allo-HSCT after nivo was not restricted within the studies and was at the discretion of treating clinicians; some pts were referred and elected to undergo subsequent allo-HSCT. Allo-HSCT-related immune complications, including graft vs host disease (GVHD) after prior exposure to PD-1 blockade have been reported (Nivolumab US PI; 2016). Here we report safety outcomes in HL pts from these 2 studies who received nivo and subsequent allo-HSCT. Methods: Pts from the CheckMate 039 cHL monotherapy cohort (n=23) and all CheckMate 205 cohorts (n=243) who underwent allo-HSCT after study treatment are included in this post hoc analysis. Basic post-allo-HSCT outcomes (transplant date, GVHD, disease status) were prospectively collected in CheckMate 205. Further details from CheckMate 205 (stem cell source, preparative regimen, additional post-allo-HSCT safety data) and all post-allo-HSCT data from CheckMate 039 were collected retrospectively. Non-relapse mortality (NRM) was defined as death without disease relapse. Steroid-responsive febrile syndrome (SRFS) was defined as steroid-responsive, non-infectious fever that could be accompanied by skin, joint, or liver symptoms. Results: This analysis includes pts from CheckMate 039 (n=5) and 205 (n=12) who underwent allo-HSCT. Median age at time of allo-HSCT was 33 y (range 18-56). Pts had received a median of 9 nivo doses (range 4-16); 16 underwent allo-HSCT without disease progression or intervening therapy between nivo and allo-HSCT; the remaining pt had disease progression on nivo and received combination chemotherapy before allo-HSCT. Median interval between last nivo dose and allo-HSCT was 29 d (range 11-94). Stem cell source was peripheral blood (n=14) or bone marrow (n=3). Donors were HLA-matched sibling (n=3), single-antigen mismatched related (n=1), haploidentical (n=5), matched unrelated (n=7), and mismatched unrelated (n=1). Reduced