Reduced incidence of relapse and CMV reactivation after check-point inhibitors relative to brentuximab vedotin as salvage therapy before allogeneic stem cell transplantation for refractory/relapsed Hodgkin lymphoma: a retrospective analysis

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The introduction of checkpoint inhibitors (CPI) and brentuximab vedotin (BV) as salvage therapy before allogeneic stem cell transplantation (Allo-SCT) has improved the outcome of patients with relapsed/refractory Hodgkin lymphoma, but a direct comparison between the two treatments is not available. We retrospectively analyzed 72 consecutive patients receiving an Allo-SCT at our institution after salvage therapy comprising either BV (n= 28) or CPI (n=44).  With a median follow-up of 63 months, 5-year cumulative incidence of relapse was significantly reduced in the cohort treated with CPI relative to BV (5% vs 37%, p<0.001) resulting in enhanced progression free survival (79% vs 56%, p=0.049). No differences were observed in terms of 5-year non-relapse mortality (16% vs 7%, p=0.305), acute and chronic graft versus host disease (GVHD), overall (OS) and GVHD/relapse free survival. Remarkably, 1-year cumulative incidence of CMV re-activation and bacterial infection were significantly reduced in the CPI group relative to BV: 32% vs 57% (p=0.012) and 18% vs 41% (p=0.041).

In conclusion, CPI usage as salvage therapy represents a better bridge to Allo-SCT due to improved disease control, but it does not translate in improved OS probably because of a slight increase in post-transplant toxicity.