Experts Debate Allo-HCT for Patients with Hodgkin Lymphoma Relapsing After Auto-HCT

Recent successes using targeted antibody therapies to treat Hodgkin lymphoma (HL) have led to a re-evaluation of established treatment paradigms. In this Point-Counterpoint feature in Blood Advances, two leaders in the field of hematology debate whether all patients with HL who relapse after autologous HCT should be considered for allogeneic HCT.

Karl S. Peggs, M.D., of the University College London Cancer Institute, presents the following clinical evidence behind his conclusion that “We should at least still consider allogeneic HCT for any patient who relapses after autologous HCT.”

  • After repeat treatment with brentuximab vedotin (BV), there is no apparent plateau in progression-free survival (PFS)
  • The number of lines of prior therapy becomes an important predictor of non-relapse mortality after allogeneic HCT, adversely impacting survival outcomes
  • With either nivolumab or pembrolizumab, approximately half of patients lose response by 12 to 15 months

Craig H. Moscowitz, M.D., of Memorial Sloan Kettering Cancer Center, presents clinical evidence that leads him to conclude: “A consult, yes; a transplant, not necessarily.” He supports referral for an allogeneic HCT consult only for patients with advanced-stage or early-stage disease that cannot be irradiated. Dr. Moscowitz contends:

  • Radiotherapy is the single most effective modality of therapy for HL and should be administered in patients in which autologous HCT fails, provided the disease can be encompassed into reasonable radiation field
  • Because the majority of patients have widespread disease post-autologous HCT, the use of radiotherapy for advanced-stage HL makes little sense other than for palliation
  • Because the majority of patients with HL will have received BV before or directly after autologous HCT as part of salvage or maintenance programs, checkpoint inhibitors should be the treatment of choice for post-autologous HCT failures

Peggs KS, et al. Blood Advances

Moscowitz CH, et al. Blood Advances

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