Sanjal H. Desai, Alison J. Moskowitz, Reid W. Merryman, Harsh R. Shah, Levi Pederson, Susan Geyer, Nivetha Ganesan, Tiffany Chang, Tamer Othman, Ayo Falade, Gunjan L. Shah, Urshila Durani, Nuttavut Sumransub, Lay She Ng, Margaret Kelsey Baron, Shin Yeu Ong, Kevin Yoon, Stephen M. Ansell, Philippe Armand, Siddharth Iyengar, Ivana N. Micallef, Robert Stuver, Alex F. Herrera, Matthew Mei
ABSTRACT: Combination therapy incorporating programmed cell death protein 1 (PD-1) blockade results in unprecedented response rates in both frontline and relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL). Previous retrospective studies have suggested benefit for PD-1 blockade before autologous stem cell transplant (ASCT) but included few patients receiving PD-1 blockade with cytotoxic chemotherapy. To explore the impact of anti-PD-1 based salvage on outcomes for patients with R/R cHL, we retrospectively reviewed 1280 patients with R/R cHL who underwent ASCT from 2010 to 2022 at 6 transplant centers, none of whom received PD-1 blockade as part of frontline therapy. Overall, 25% received a PD-1 inhibitor at any point before ASCT (10% in conjunction with chemotherapy), 28% received salvage brentuximab vedotin (BV) without PD-1 blockade, and the rest received salvage chemotherapy alone. Patients who received PD-1 inhibitors at any point before ASCT had a significantly higher 2-year progression-free survival than those who received BV without PD-1 inhibitors or patients receiving chemotherapy alone (88.2%, 70.2%, and 67.4%, respectively; P< .0001). When restricted to patients in complete response before ASCT, the benefit of PD-1 blockade remained significant. PD-1 blockade before ASCT is independently associated with superior post-ASCT outcomes and patients proceeding to ASCT should be treated with PD-1-based salvage.