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

  • Elisa Lucchini Department of Hematology, Azienda Sanitaria Universitaria Giuliano- Isontina, Trieste, Italy.
  • Chiara Rusconi Division of Hematology and Stem Cell Transplantation Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
  • Mario Levis Department of Oncology, University of Torino, Italy.
  • Francesca Ricci Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy.
  • Armando Santoro Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy.
  • Umberto Ricardi Department of Oncology, University of Torino, Italy.
  • Stefano Volpetti Department of Hematology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
  • Fabio Matrone Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy.
  • Anna Di Russo Division of Radiotherapy Oncology Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
  • Manuela Caizzi Department of Hematology, Azienda Sanitaria Universitaria Giuliano- Isontina, Trieste, Italy.
  • Anna Schiattarella Department of Radiotherapy, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy.
  • Francesco Zaja | francesco.zaja@asugi.sanita.fvg.it Department of Hematology, Azienda Sanitaria Universitaria Giuliano- Isontina, Trieste; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.

Abstract

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.

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Published
2021-06-09
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Original Articles
Keywords:
Nivolumab; pembrolizumab; radiotherapy; Hodgkin lymphoma; ICI-RT
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How to Cite
Lucchini, E., Rusconi, C., Levis, M., Ricci, F., Santoro, A., Ricardi, U., Volpetti, S., Matrone, F., Di Russo, A., Caizzi, M., Schiattarella, A., & Zaja, F. (2021). Immune checkpoint inhibitors in combination with radiotherapy as salvage treatment for relapsed/refractory classical Hodgkin lymphoma: A retrospective analysis in 12 patients. Hematology Reports, 13(2). https://doi.org/10.4081/hr.2021.9080