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Nivolumab salvage therapy before or after allogeneic stem cell transplantation in Hodgkin lymphoma

Bone Marrow Transplantation volume 52, pages 1074–1077 (2017)Cite this article

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Hodgkin’s lymphoma (HL) is one of the most curable adult malignancies. However, management of disease refractory to primary induction or relapsing after remission becomes challenging and long-term disease control can only be achieved by salvage chemotherapy followed by autologous stem cell transplantation (ASCT).1 On the other hand, relapse post ASCT is more challenging, and even though numerous salvage options are available, no standard recommendations for relapse post ASCT have been established. The salvage options include the following: novel immunotherapeutic agents such as anti CD30 Ab like Brentuximab Vedotin (Bv),2 chemotherapy such as bendamustine (Benda),3, 4, 5 combination of Bv and chemotherapy, anti-PD-1 Ab like Nivolumab,6 and allogeneic hematopoietic stem cell transplantation (allo-SCT).7 Several reports are available on safety and efficacy of Bv;8, 9 however, data are scarce on the use of Nivolumab before or after transplantation. We report a retrospective multicenter study to assess the outcomes of HL patients treated with Nivolumab before or after allo-SCT.

This study was conducted in two transplant referral centers in Lebanon: the American University of Beirut Medical Centre and Makassed University Hospital. We identified and analyzed the outcome and toxicity in 11 patients with HL treated with Nivolumab before or after allo-SCT. Nine patients received Nivolumab as a bridge to allo-SCT, while two patients received it as salvage for relapse post allo-SCT. The primary end point of the study was the feasibility (safety) of Nivolumab before or after allo-SCT. Secondary end points included objective response rate (ORR), GVHD, successful bridging to allo-SCT when relevant and transplant outcomes. Chimerism fragment analysis was done via amplification of short tandem repeat sequences on DNA extracted from total peripheral blood white cells on days 30, 60, 90 and beyond. Complete donor chimerism is defined by more than 95% donor chimerism.

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Acknowledgements

We thank the nursing staff for providing excellent care for our patients and the physicians in the Hematology and Oncology division at the American University of Beirut Medical Center and referring physicians from Lebanon and the Middle East region for their significant contributions and dedicated patients’ care.

Author contributions

Jean El-Cheikh contributed to study design, collected and analyzed data, performed statistical analysis, provided clinical care and wrote and revised the manuscript. Radwan Massoud, Imane Abudalle, Basel Haffar, Anas Mougharbel and Tamima Jisr collected data and edited the manuscript. Rami Mahfouz performed molecular analysis and edited the manuscript. Mohamed A Kharfan-Dabaja contributed to study design, provided clinical care and edited the manuscript. Ahmad Ibrahim and Ali Bazarbachi designed transplant program in each institution, contributed to study design, recruited patients, provided clinical care and edited the manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Bone Marrow Transplantation Program, American University of Beirut Medical Center, Beirut, Lebanon

    J El Cheikh, R Massoud, I Abudalle, B Haffar & A Bazarbachi

  2. Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon

    R Mahfouz

  3. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    M A Kharfan-Dabaja

  4. Division of Hematology and Oncology, Makassed University Hospital, Beirut, Lebanon

    T Jisr, A Mougharbel & A Ibrahim

Authors
  1. J El Cheikh
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  2. R Massoud
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  6. M A Kharfan-Dabaja
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  9. A Ibrahim
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  10. A Bazarbachi
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Corresponding authors

Correspondence to J El Cheikh or A Bazarbachi.

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El Cheikh, J., Massoud, R., Abudalle, I. et al. Nivolumab salvage therapy before or after allogeneic stem cell transplantation in Hodgkin lymphoma. Bone Marrow Transplant 52, 1074–1077 (2017). https://doi.org/10.1038/bmt.2017.69

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