Anti-PD1 Consolidation in Patients with Hodgkin Lymphoma at High Risk of Relapse after Autologous Stem Cell Transplantation: A Multicenter Real-Life Study

SIMPLE SUMMARY: Autologous stem cell transplantation (ASCT) represents a standard strategy for patients with relapsed and refractory (RR) Hodgkin Lymphoma (HL). Unfortunately, patients displaying some pre-transplant adverse predictors eventually progress, requiring further treatments and several succumb to their lymphoma. This retrospective multicenter study aimed to evaluate the effectiveness of programmed death receptor-1 (PD-1)-blockade as a consolidation treatment for patients with RR-HL at high risk of ASCT failure. We collected data from 26 patients with ≥2 risk factors for recurrence who had received anti-PD1 consolidation after ASCT. Patients received a median of 13 consolidation courses (range 6–30), without toxicity-related discontinuations. At a median follow-up of 25.8 months post-ASCT, the median progression-free (PFS) was 42.6 months, with a 2-year PFS and overall survival rates of 79% and 87%, respectively. Post-ASCT consolidation with anti-PD1 is feasible and effective and may represent a valuable management option for patients at high risk of recurrence. ABSTRACT: (1) Background: Consolidation therapy is an emerging strategy for patients with relapsed/refractory (RR) Hodgkin Lymphoma (HL) at high risk of failing salvage autologous stem cell transplantation (ASCT). (2) Objectives: To assess the safety and effectiveness of PD1-blockade consolidation for these high-risk patients. (3) Design: Multi-center retrospective analysis. (4) Methods: We identified 26 patients given anti-PD1 consolidation, from June 2016 to May 2020. (5) Results: Patients displayed the following risk factors: refractory disease (69%), relapse < 12 months from upfront therapy (15%), ≥2 lines of salvage therapy (73%), extranodal disease (65%). Nineteen patients (73%) had ≥3 of these factors. In addition, 16 patients (61%) also displayed PET-positive (Deauville ≥ 4) disease before ASCT. Treatment-related adverse events (TRAEs), never graded > 3, occurred in 12 patients (46.15%) and mainly included skin rashes (41.7%), transaminitis (33.3%), and thyroid hypofunction (25%). Patients completed a median of 13 courses (range 6–30). At a median follow-up of 25.8 months post-ASCT, the median progression-free (PFS) was 42.6 months, with a 2-year PFS and overall survival rates of 79% and 87%, respectively. (6) Conclusions: Post-ASCT consolidation with anti-PD1 is feasible and effective. Further studies are warranted to define the optimal treatment length and patients’ subsets more likely to benefit from this approach.