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TOPLINE
Survival outcomes for both autologous and allogeneic hematopoietic cell transplantation (HCT) in patients with relapsed or refractory classical Hodgkin lymphoma improved between 2010 and 2022, a retrospective cohort study showed. Declining relapse incidence appeared to contribute substantially to the improved outcomes.
METHODOLOGY
- Autologous HCT is the standard of care for primary refractory or relapsed Hodgkin lymphoma; allogeneic transplantation is indicated for patients with unsuccessful autologous transplantation. The introduction of novel therapeutic agents and improvements in donor selection, conditioning regimens, and graft-vs-host disease (GVHD) prophylaxis might improve post-transplantation outcomes; however, supporting data remain limited.
- Researchers conducted a retrospective, registry-based cohort study using data from the European Society for Blood and Marrow Transplantation. The study included 19,498 patients aged 18 years or older with relapsed or refractory classical Hodgkin lymphoma who underwent a first autologous transplantation (n = 15,648; median age, 35 years; 57% men) or a first allogeneic transplantation (n = 3850; median age, 32 years; 59% men) between January 2010 and December 2022.
- Primary endpoints were overall survival and progression-free survival assessed at 2 and 5 years after HCT; secondary endpoints were nonrelapse mortality and relapse incidence. Among allogeneic transplant recipients, secondary endpoints also included acute and chronic GVHD, and GVHD-and-relapse-free survival.
- The median follow-up duration was 2.4 years for autologous transplant recipients and 3.9 years for allogeneic transplant recipients.
TAKEAWAY
After autologous transplantation, 2-year progression-free survival increased from 63% to 73%, and overall survival increased from 85% to 93% between 2010-2014 and 2019-2022. Relapse incidence also fell from 33% to 25%.
- After allogeneic transplantation, 2-year progression-free survival increased from 44% to 62% and overall survival increased from 66% to 72% over the same time period; 2-year relapse incidence also decreased progressively from 40% to 18%.
- Both transplantation types were associated with significantly better progression-free and overall survival and lower relapse incidence during 2019-2022.
- Among allogeneic transplant recipients, checkpoint inhibitor use before transplantation was associated with lower relapse incidence and improved progression-free survival, but a higher risk of grade 2-4 acute GVHD.
IN PRACTICE
The study authors concluded that "outcomes after auto-HCT and allo-HCT continue to improve" and suggested that the findings provide a basis for prospective studies evaluating strategies to further reduce relapse after transplantation.
SOURCE
The study, led by Ali Bazarbachi, MD, Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Lebanon, was published online in The Lancet Haematology.
LIMITATIONS
The study was registry-based and retrospective. Data on treatment-related toxicity with brentuximab vedotin and checkpoint inhibitor exposure were limited. Disease status categorization according to local criteria rather than centralized review may have introduced variability. Additionally, shortage of data on post-transplantation consolidation restricted analysis of its influence on outcomes after autologous HCT.
DISCLOSURES
The study did not receive any specific funding. Bazarbachi disclosed receiving payment for speakers bureaus or advisory board participation from Novartis, Roche, Sanofi, Jazz, Adienne, Astellas, Takeda, Hikma, Janssen, MSD, AbbVie, Pfizer, and Amgen, as well as research support from Novartis, Roche, Takeda, Janssen, Biologix, and Pfizer. Full disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
