13 april 2021: Bron: Blood Adv (2021) 5 (6): 1648–1659.

Een autologe stamceltransplantatie na immuuntherapie met anti-PD medicijnen (checkpointremmers) geeft hele goede resultaten op de overall overleving en complete remissies bij hoogrisicopatiënten met gevorderde lymfklierkanker met hodgkin lymfomen die ondanks meerdere behandelingen toch een recidief of progressie van hun ziekte lieten zien. Zelfs bij zwaar voorbehandelde patiënten waar chemokuren niet aansloegen en die in het algemeen beschouwd worden als verder ongeneeslijk, waren heel veel complete remissies te zien. De progressievrije overleving en overall overlevingspercentages na 18 maanden waren respectievelijk 81% en 96%.
Bij de patiënten waar de immuuntherapie geen effectieve resultaten had laten zien was de progressievrije overleving veel minder, maar nog altijd 51 procent. 

Aan de studie deden uiteindelijk 78 patiënten met klassiek Hodgkin-lymfoom mee die na een succesvolle behandeling met immuuntherapie met anti-PD medicijnen daaropvolgend een autologe stamceltransplantatie ondergingen als een derdelijns- of nog latere palliatieve behandeling. Van de 60 patiënten die immuuntherap[ie als alleenstaande behandeling kregen, kregen er 37 nivolumab (62%), 22 kregen pembrolizumab (37%) en 1 kreeg avelumab (1%).

graphic


Het volledige studierapport is gratis in te zien of te downloaden. Klik op de titel van het abstract.

LYMPHOID NEOPLASIA| 
Blood Adv (2021) 5 (6): 1648–1659.

Key Points

  • ASCT after PD-1-blockade resulted in very favorable outcomes among high-risk patients with multiply relapsed/refractory HL.

  • Response to PD-1 blockade, and not prior chemosensitivity, best predicted post-ASCT PFS in this cohort.

Visual Abstract

Abstract

Autologous stem cell transplantation (ASCT) can be curative for patients with relapsed/refractory Hodgkin lymphoma (HL). Based on studies suggesting that anti-PD-1 monoclonal antibodies (mAbs) can sensitize patients to subsequent chemotherapy, we hypothesized that anti-PD-1 therapy before ASCT would result in acceptable outcomes among high-risk patients who progressed on or responded insufficiently to ≥1 salvage regimen, including chemorefractory patients who are traditionally considered poor ASCT candidates.
We retrospectively identified 78 HL patients who underwent ASCT after receiving an anti-PD-1 mAb (alone or in combination) as third-line or later therapy across 22 centers. Chemorefractory disease was common, including 42 patients (54%) refractory to ≥2 consecutive systemic therapies immediately before anti-PD-1 treatment.

Fifty-eight (74%) patients underwent ASCT after anti-PD-1 treatment, while 20 patients (26%) received additional therapy after PD-1 blockade and before ASCT. Patients received a median of 4 systemic therapies (range, 3-7) before ASCT, and 31 patients (41%) had a positive pre-ASCT positron emission tomography (PET) result. After a median post-ASCT follow-up of 19.6 months, the 18-month progression-free survival (PFS) and overall survival were 81% (95% CI, 69-89) and 96% (95% confidence interval , 87-99), respectively. Favorable outcomes were observed for patients who were refractory to 2 consecutive therapies immediately before PD-1 blockade (18-month PFS, 78%), had a positive pre-ASCT PET (18-month PFS, 75%), or received ≥4 systemic therapies before ASCT (18-month PFS, 73%), while PD-1 nonresponders had inferior outcomes (18-month PFS, 51%).

In this high-risk cohort, ASCT after anti-PD-1 therapy was associated with excellent outcomes, even among heavily pretreated, previously chemorefractory patients.

Correspondence: Alex Herrera, Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA 91010; e-mail:aherrera@coh.org.

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Author notes

The full-text version of this article contains a data supplement.

Supplemental data




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