Pembrolizumab for the Treatment of Relapsed and Refractory Classical Hodgkin Lymphoma After Autologous Transplant and in Transplant-Naïve Patients

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2022-08, Vol.22 (8), p.589-595
• Main Authors: Halahleh, Khalid, Al Sawajneh, Suhaib, Saleh, Yacob, Shahin, Omar, Abufara, Alaa, Ma'koseh, Mohamad, Abdel-Razeq, Rashid, Barakat, Fareed, Abdelkhaleq, Hadeel, Al-Hassan, Nadira, Atiyyat, Reem, Al-Faker, Noor, Omari, Zaid, Ghatasheh, Hamza, Jaradat, Imad, Muradi, Isa, Iyad, Sultan, Bazarbachi, Ali
• Format: Article
• Language: English
• Subjects: Checkpoint inhibitors; Hematopietic Cell Transplantation; KHCC; Pembrolizumab; Relapsed Hodgkin's Lymphoma
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2022.02.009

Checkpoint inhibitors demonstrated significant efficacy in relapsed/refractory Hodgkin's Lymphoma (R/R cHL) resulting in high responses and prolonged progression free survival in patients, who relapse after or are ineligible for autologous stem cell transplantation (auto-SCT). We aimed to assess the efficacy and toxicity of Pembrolizumab before auto-SCT and in transplant naïve patients and calculate survival outcomes. Fifty-five patients with R/R cHL were included. Patients demographics, including age, sex, risk stratification, therapy received and details pertaining transplantation, were collected. Median age was 28 years (range, 16-62 years). The median follow-up was 15.3 months and the median number of previous treatments was 3 (1-10). The best objective response was 74.5% (CR 32.7%, SD 5.5%) with reasonable safety profile. Twenty-nine of the responding patients received subsequent auto-SCT and 9 allogeneic stem cell transplantation (allo-SCT), 6 are currently alive with ongoing response. At the time of analysis, 6 patients remained on Pembrolizumab and the rest discontinued. The main reason for discontinuation was disease progression (n-49). Twelve-months overall survival and progression free survival (PFS) was 92% (95% CI: 76%-95%) and 51% (95% CI, 39%-67%) respectively. Twelve-month PFS for patients, who achieved CR or PR or PD was 88% (95% CI: 07%-75%); PR 60% (95% CI: 21%-29%) and 5% (95% CI: 5%-0%). Though the number of patients who received auto-SCT after Pembrolizumab was small (n-15), 12 months overall survival and PFS 100% and PFS 92%. 11 patients (20%) deceased during the follow-up and none was regarded to be treatment-related. Checkpoint inhibitors are effective in heavily pretreated cHL patients with reasonable survival outcomes. The results supporting the concept of auto and/or allo-SCT after checkpoint inhibitors use. Checkpoint inhibitors are effective in relapsed refractory classical Hodgkin's Lymphoma (R/R cHL) with high objective and complete remission rates and reasonable survival outcomes and safety profile. The results of this retrospective cohort study support the concept of auto and/or allo-stem cell transplantation (allo-SCT) consolidation after CPIs use.