Nivolumab is approved for the treatment of progressive Hodgkin lymphoma (HL) after autologous haematopoietic stem-cell transplantation (HSCT) and brentuximab vedotin therapy. Allogeneic HSCT (allo-HSCT) is also indicated in this setting, and can result in long-term survival in some, but not all, patients; nivolumab is a potential rescue therapy, although graft-versus-host disease (GVHD) is a concern. Now, Franck Morschhauser et al. have reported a retrospective analysis of all patients who received nivolumab after allo-HSCT via a French authorization for temporary use programme.
Among 20 patients identified, the overall response rate was 95%, and median progression-free survival (PFS) was not reached at a median of 370 days. Prof. Morschhauser, of the University of Lille, France, adds, “at this point, the PFS curve reached a plateau, with 12 patients in first ongoing response, and another in durable response after re-treatment with nivolumab; six patients remain disease-free despite discontinuation of nivolumab (they received only a single dose).” Of note, these patients previously had a median time to disease progression after allo-HSCT of 8.5 months, and the response rate in the registrational trial of nivolumab in HL was 66%, raising the possibility that nivolumab might have enhanced efficacy post allo-HSCT.
Tempering these encouraging results, GVHD occurred in six patients and, subsequently, two GVHD-related deaths occurred. All six patients had a history of acute GVHD, which might reflect a high level of alloreactivity. As Morschhauser explains, “nivolumab therapy necessitates careful monitoring for GVHD, particularly if the patient has a prior history of acute GVHD and is treated within 1 year after allo-HSCT.”
He concludes: “we believe that nivolumab is a suitable option for treating HL after allo-HSCT, with a potentially better risk–benefit ratio than other therapies. Our encouraging results should be confirmed prospectively in a larger cohort.”
References
Herbaux, C. et al. Efficacy and tolerability of nivolumab after allogeneic transplantation for relapsed Hodgkin's lymphoma. Blood http://dx.doi.org/10.1182/blood-2016-11-749556 (2017)
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Killock, D. Anti-PD-1 therapy with nivolumab after allo-HSCT for Hodgkin lymphoma. Nat Rev Clin Oncol 14, 264 (2017). https://doi.org/10.1038/nrclinonc.2017.50
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DOI: https://doi.org/10.1038/nrclinonc.2017.50