Graft-versus-host disease (GVHD) is the most frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and a significant cause of morbidity and mortality. Systemic steroid therapy is the basis of treatment for GVHD; however, some patients are refractory to treatment. There are concerns about an increased incidence of GVHD for patients with Hodgkin lymphoma (HL) previously treated with immune checkpoint inhibitors (ICIs). In addition, data about patients with steroid-refractory form of GVHD in this setting is limited. The aim of this study was to define incidence of GVHD and investigate current treatment options for patients with rrHL after bridge therapy with immune checkpoint inhibitors.
We retrospectively evaluated the results of allo-HSCT in 23 adult patients after ICIs -based therapy. Complete response to PD-1 therapy before allo-HSCT was documented in 9 patients (39%), partial response- in 6 patients (26%), 5 patients (22%) had disease progression and 3 patients (13%) were transplanted in indeterminate response. All patients received reduced-intensity conditioning regimenand PTCy-based GvHD prophylaxis.
At the time of analysis, median follow-up was 14 months.The 1-year OS and EFS were 83% and 74% respectively. Out of the 20 patients with engraftment 15 patients developed acute GVHD. Four patients had a steroid-refractory aGVHD. As a second line of therapy patients received single-agent ruxolitinib (n=2) or combination of ruxolitinib with extracorporeal photopheresis (ECP) and steroids (n=2) and all patients achieved complete response. Ten patients had chronic GVHD. Four patients with steroid-refractory cGVHD achieved CR receiving combined immunosuppressive therapy (ruxolitinib and steroids,n=2;steroids+cyclosporine A and ECP,n=2). One patient with severe skin cGVHD achieved PR on combination of steroids and ECP, another patient with a severe refractory cGVHD achieved stabilization only with third line of therapy (ruxolitinib+imatinib).
Introduction of target agents for srGVHD might ameliorate GVHD-related mortality and morbidity in rrHL patients after ICIs.
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