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Blood. 2019 Apr 5. pii: blood.2019000215. doi: 10.1182/blood.2019000215. [Epub ahead of print]

PD-1 Blockade with Pembrolizumab for Classical Hodgkin Lymphoma after Autologous Stem Cell Transplantation.

Author information

1
Medical Oncology, Dana-Farber Cancer Institute, United States parmand@partners.org.
2
Bone Marrow Transplantation, Massachusetts General Hospital, United States.
3
DFCI, United States.
4
Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, United States.
5
Dana-Farber Cancer Institute, United States.
6
Dana Farber Cancer Institute, United States.
7
Memorial Sloan Kettering Cancer Center.
8
Stem Cell Transplant and Cellular Therpy, The University of Texas MD Anderson Cancer Center, United States.
9
Medical Oncology, DFCI, United States.
10
Medical Oncology, Dana-Farber Cancer Institute, United States.
11
Department of Medical Oncology, Dana-Farber Cancer Institute, United States.
12
Dana-Farber Cancer Institute.
13
Hematopathology, Brigham & Women's Hospital, United States.
14
Hematologic Malignancies, Dana-Farber Cancer Institute, United States.
15
Brigham and Women’s Hospital.
16
Department of Medicine, Dana-Farber Cancer Institute, United States.
17
City of Hope Medical Center, United States.

Abstract

Autologous stem cell transplantation (ASCT) remains the standard of care for patients with relapsed/refractory classical Hodgkin lymphoma (RR cHL) who respond to salvage chemotherapy. However, relapse after ASCT remains a frequent cause of treatment failure, with poor subsequent prognosis. Since cHL is uniquely vulnerable to PD-1 blockade, PD-1 blockade given as consolidation after ASCT could improve ASCT outcomes. We therefore conducted a multi-cohort phase 2 study of pembrolizumab in patients with RR cHL after ASCT, hypothesizing that it would improve the progression-free survival (PFS) at 18 months after ASCT (primary endpoint) from 60% to 80%. Pembrolizumab was administered at 200mg IV every 3 weeks for up to 8 cycles, starting within 21 days of post-ASCT discharge. 30 patients were treated on this study. The median age was 33, and 90% were high-risk by clinical criteria. 77% completed all 8 cycles. Toxicity was manageable, with 30% of patients experiencing at least 1 grade 3 or higher adverse event (AE), and 40% at least 1 grade 2 or higher immune-related AE. 2 pts were lost to follow-up in complete remission at 12 months. The PFS at 18 months for the 28 evaluable patients was 82%, meeting the primary endpoint. The 18-month overall survival was 100%. In conclusion, pembrolizumab was successfully administered as post-ASCT consolidation in patients with RR cHL, and resulted in a promising PFS in a high-risk patient cohort, supporting the testing of this strategy in a randomized trial. This trial is registered at clinicaltrials.gov (NCT02362997).

PMID:
30952672
DOI:
10.1182/blood.2019000215

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