EBMT 2025 | The evolution of SCT in Hodgkin lymphoma with the introduction of BV and checkpoint inhibitors

So basically, the landscape of treatment of Hodgkin lymphoma, whether frontline or relapsed/refractory Hodgkin lymphoma, has totally changed with the introduction of new monoclonal antibodies, brentuximab vedotin, as well as checkpoint inhibitors. So, autotransplant remains the standard of care for relapsed/refractory Hodgkin lymphoma with significantly improving results over time of autografted patients, mainly because brentuximab vedotin and checkpoint inhibitors are increasingly used before autotransplant as part of the salvage therapy or after autotransplant as consolidation and or maintenance. 

For patients who relapse after autotransplant, we show that we have a steady increase over time in overall survival for this category of patients. Allogeneic transplant is recommended as curative strategy for patients who fail autotransplant, with again improving results over time for autotransplant. But the numbers of autotransplant and allogeneic transplant are decreasing because we are curing more patients with frontline therapy, so we have less candidate for autotransplant, and we are curing more patients at first relapse, so we have less candidate for allogeneic transplants. 

For patients who relapse after auto, as I mentioned, allogeneic transplant is recommended except maybe for patients who achieve a complete remission with brentuximab vedotin and or checkpoint inhibitor-based salvage, in that case, allogeneic transplant might be deferred. 

Finally, brentuximab vedotin and checkpoint inhibitors can be safely used before or after allogeneic transplant, but we have to be cautious for checkpoint inhibitors not to use them very close to the allogeneic transplant and to use post-transplant cyclophosphamide for GvHD prophylaxis.

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