Immune checkpoint inhibitors in combination with radiotherapy as salvage treatment for relapsed/refractory classical Hodgkin lymphoma: A retrospective analysis in 12 patients

• Main Authors: Elisa Lucchini, Chiara Rusconi, Mario Levis, Francesca Ricci, Armando Santoro, Umberto Ricardi, Stefano Volpetti, Fabio Matrone, Anna Di Russo, Manuela Caizzi, Anna Schiattarella, Francesco Zaja
• Format: Article
• Language: English
• Published: PAGEPress Publications 2021-06-01
• Series: Hematology Reports
• Subjects: Nivolumab; pembrolizumab; radiotherapy; Hodgkin lymphoma; ICI-RT
• Online Access: https://www.pagepress.org/journals/index.php/hr/article/view/9080
• ISSN: 2038-8322; 2038-8330

The rate of complete remission (CR) with the anti-PD1 immune checkpoint inhibitors (ICI) nivolumab (N) and pembrolizumab (P) in patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL) is low (20-30%), and the majority of patients eventually relapse. One strategy to improve their outcome is to combine ICI with radiotherapy (ICI-RT), taking advantage of a supposed synergistic effect. We retrospectively collected data of 12 adult patients with R/R cHL treated with ICI-RT delivered during or within 8 weeks from the start or after the end of ICI. Median age at ICI-RT was 37 years, 50% had previously received an autologous stem cell transplantation (SCT) and 92% brentuximab vedotin. RT was given concurrently, before or after ICI in 4, 1 and 7 patients. Median RT dose was 30Gy, for a median duration of 22 days. Median number of ICI administrations was 15. Overall response and CR rate were 100% and 58%. Nine patients received subsequent SCT consolidation (7 allogeneic and 2 autologous). After a median follow-up of 18 months, 92% of patients were in CR. No major concerns about safety were reported. ICI-RT combination appears to be a feasible and highly active bridge treatment to transplant consolidation.