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616 Evolution of Outcome over Time for Relapsed Hodgkin Lymphoma after Autologous Stem Cell Transplant: Improved Survival for Early Relapse in Recent Years

Program: Oral and Poster Abstracts
Type: Oral
Session: 731. Clinical Autologous Transplantation: Building Better Transplant Platforms in Lymphoid Malignancies
Hematology Disease Topics & Pathways:
Biological, Diseases, Hodgkin Lymphoma, Therapies, Lymphoid Malignancies, Clinically relevant, transplantation
Monday, December 7, 2020: 9:30 AM

Ali Bazarbachi, MD, PhD1,2, Ariane Boumendil Sr., PhD3*, Hervé Finel Sr., MD, PhD4*, Irma Khvedelidze4*, Joanna Romejko-Jarosinska5*, Alina Daniela Tanase, MD PhD6*, Saad Akhtar, MD7*, Tarek Ben Othman8*, Abdelghani Tbakhi, MD9*, Boris Afanasyev, MD, PhD10*, Javier Briones, MD, PhD11*, Zafer Gülbas, MD12*, Jean Elcheikh, MD13*, Rose-Marie Hamladji, MD, PhD14*, Tugrul Elverdi, MD15*, Didier Blaise, MD16, Carmen Martinez, MD, PhD17*, Eleonora Alma18*, Kazimierz Halaburda, MD, PhD19*, Aida Botelho de Sousa20,21*, Bertram Glass22*, Stephen Robinson23*, Silvia Montoto, MD24 and Anna Sureda Balari, MD, PhD25*

1Department of Cell Biology, Anatomy and Physiological Sciences, American University of Beirut, Beirut, Lebanon
2Bone Marrow Transplantation Program/Division of Hematology-Oncology, Department of Internal Medicine, American University of Beirut Dept. of Medicine, Beirut, Lebanon
3Lymphoma Working Party of EBMT, Paris, France
4Lymphoma Working Party, EBMT, Paris, France
5Maria Sklodowska-Curie Institute-Oncology Center, Department of Lymphoid Malignancies,, warsaw, Poland
6Bone Marrow Transplantation Unit, Fundeni Clinical Hospital, Bucharest, Romania
7Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
8Hematology and transplant department, Centre National de Greffe de Moelle Osseuse de Tunis. Tunisia, Tunis, Tunisia
9Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
10First State Pavlov Medical University of St. Petersburg Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russian Federation
11Department of Hematology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
12Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
13Bone Marrow Transplantation Program and Division of Hematology/oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
14Service Hématologie Greffe de Moëlle, Centre Pierre Et Marie Curie, Alger, Algeria
15Department of Internal Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
16Institut Paoli Calmettes, Marseille, France
17Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, IDIBAPS, Josep Carreras Research Institute, Hospital Clínic, Barcelona, Spain
18University Policlinico Gemelli Foundation, IRCCS, Catholic University of the Sacred Heart, Roma, ITA
19Institute of Hematology and Transfusion Medicine, Warsaw, Poland
20Hospital dos Capucho, Lisboa, Portugal
21Hospital dos Capuchos (CHULC), Lisboa, Portugal
22Clinic for Hematology, Oncology, Tumorimmunology and Palliative Care, Helios Clinic Berlin-Buch, Berlin, Germany
23University Hospital Bristol, Bristol, United Kingdom
24Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
25Institut Català d'Oncologia-Hospital Duran i Reynals, Hospitalet del Llobregat, Spain

Salvage chemotherapy and autologous stem cell transplantation (auto-SCT) results in the cure of around 50% of patients with Hodgkin lymphoma (HL) failing first line therapy. In historical data, patients who progressed after auto-SCT had a poor outcome, with a median overall survival (OS) of around 1-2 years. Significant progress has been achieved in the last decade with the use of brentuximab vedotin (BV) or check-point inhibitors (CPI) and the increasing use of haploidentical transplant. However, little information is available about the characteristics and real-world outcomes of patients with HL relapsing after auto-SCT in the current era. To assess prognosis of patients with recurrent-HL post auto-SCT over time, we analyzed the European Blood and Marrow Transplant registry data of 1781 adult HL patients who relapsed between 2006 and 2017 after a first auto-SCT. A specific questionnaire was sent to all participant centers to obtain additional data regarding characteristics of the patients, treatment of relapse and outcome after auto-SCT failure. Detailed data were collected for 760 patients [median age 32; interquartile range (IQR) 25-42] included in this study. After a median follow-up for alive patients of 57 months (IQR: 29-89), the 4-year OS after relapse for the 760 included patients was 46% (95%CI: 43-50) and similar to that of 1021 non-included patients (45%, 95%CI: 41-48). The 4-year OS after relapse continuously increased from 35% (95%CI: 27-45) for 136 patients relapsing in 2006-2008, to 43% (95%CI: 37-49) for 258 patients relapsing in 2009-2011, 49% (95%CI: 43-56) for 238 patients relapsing in 2012-2014, and 61% (95%CI: 52-72) for 128 patients relapsing in 2015-2017 (p=0.001) (Figure 1). Improvement over time was predominantly noted in patients who had an early relapse (within 12 months) after auto-SCT (p=0.01) but not in those with a late relapse (p=0.6). On multivariate analysis, patients who relapsed in more recent years and those with a longer interval from transplant to relapse had a better OS, whereas increasing age, poor performance status at relapse, bulky disease at relapse, extranodal disease at relapse and presence of B-symptoms at relapse were associated with a worse OS. Regarding treatment at relapse, BV was used in 233 patients (31%) after a median of 2 months from relapse (IQR: 0.8-8), predominantly as first treatment of relapse (155 patients). BV use increased over the 4 time periods from 3% to 19%, 49% and 49% respectively, and resulted in a complete remission (CR) in 46% and a partial response (PR) in 32%. The 4-year OS from BV use for relapse after auto-SCT was 56% (95%CI: 49-64). CPI were used in 91 patients (12%) including nivolumab in 75 patients and pembrolizumab in 12 patients after a median of 18 months from relapse (IQR: 5-35). CPI use increased over the 4 time periods from 1% to 4%, 14% and 35% respectively, and resulted in a CR of 44%, PR 32%, with a 4-year OS from CPI use of 44% (95%CI: 30-63). Finally, a second SCT (SCT2) was performed in 330 patients (43%) predominantly allogeneic SCT (285 patients, 86%) including a haploidentical SCT in 54 patients (16%). SCT2 was performed in 40% and 37% of patients relapsing in 2006-2008 and 2009-2011 respectively but its use increased to 49% and 51% of patients relapsing in 2012-2014 and 2015-2017 respectively. Four-year OS after SCT2 was 55%. In conclusion, outcome after post-transplant relapse has improved significantly in recent years, particularly in the case of early relapse, possibly reflecting, among other factors, the efficacy of post-transplant salvage including BV, CPI and second transplant. These large-scale real-world data can serve as benchmark for future studies in that setting.

Disclosures: Blaise: Jazz Pharmaceuticals: Honoraria. Sureda Balari: Incyte: Consultancy; Celgene: Consultancy, Honoraria; BMS: Speakers Bureau; Roche: Honoraria; Sanofi: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Gilead/Kite: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria.

*signifies non-member of ASH