Overall survival in classic Hodgkin lymphoma pts who progress after autologous stem cell transplant in the era of novel agents

Introduction: Approximately 20% of patients (pts) with classic Hodgkin lymphoma (cHL) relapse after frontline therapy. Salvage chemotherapy and autologous stem cell transplant (ASCT) have cure rates of 60%–70%. Prior to brentuximab vedotin (BV) and checkpoint inhibitors (CPI), the median overall survival (OS) of pts with cHL relapse after ASCT was 2–3 years. Recently, CPI and BV have improved progression free survival (PFS) in this population whereas the impact on OS has not been well-described in the literature. Herein we report on OS of pts progressing after ASCT in the era of novel agents. Methods: In this multicenter retrospective study of 14 participating institutions, adult pts with cHL who progressed after ASCT were included. Age, sex, time to relapse (TTR) from ASCT, details of treatments for post-transplant progression were collected. Study objective was post-progression OS, defined as the time from post-transplant progression to death or last follow up. Results: Among 986 pts with cHL who underwent ASCT, 300 pts progressed. Median age was 32 (26–43) yr, 153 (51%) were male, 147 (49%) had TTR <6 months, 269 (89%) had TTR <24 months. Median prior lines were 2 (range: 1–9). 52 (19%) pts progressed after BV maintenance. 223 (74%) pts received BV or CPI at any point after post-ASCT progression. To assess impact of BV/CPI sequencing for post-ASCT progression on OS, pts were divided into 3 groups on the basis of first therapy received after progression: 60 (20%) received CPI first (CPI group), 140 (47%) received BV (BV group) and 108 (36%) received chemotherapy or radiation as first post-ASCT progression regimen (chemorad group). Of 140 pts in BV group, 55 (39%) received CPI as subsequent line of therapy. Of 108 pts in the chemorad group, 64 (59%) received CPI and 25 (23%) received BV as subsequent regimen for progression. 74 (47%) pts had allogeneic stem cell transplant (alloSCT). Median follow up was 4 years (0.07–11). Median OS was 9.5 (7-NA) yrs; 5-year OS was 63%, CI95: 57–72, f). In univariate analysis, age <40 and TTR >6 months were associated with higher OS (Figures 2 and 3). When adjusted for age and TTR, CPI was associated with superior OS compared to chemorad group but not BV group (Figure 4). Progression on BV maintenance was also associated with higher OS. Receipt of alloSCT was not significantly associated with OS in uni- and multivariable analysis (Figure 5). 154 pts received more than 1 line of therapy for progression. Significantly higher proportion of pts in CPI group were alive without requiring further lines of therapy compared to BV or chemo group [44 (73%), 66 (47%); 59 (52%), p < 0.005]. Conclusions: In the era of novel agents, pts with relapsed cHL after ASCT were found to have a median OS reaching almost a decade. Age >40 years and TTR < 6 months of ASCT were associated with shorter OS. Employing CPI earlier in the course may be associated with higher OS. AlloSCT was not associated with improved OS in this population. Keyword: Hodgkin lymphoma Conflicts of interests pertinent to the abstract. S. H. Desai Honoraria: Seatle Genetics K. A. Blum Research funding: BMS, Seatle Genetics