Tandem Meetings 2023 | Patient selection for autoSCT in HL & increasing CR rate before autoSCT with novel salvage regimens
Sanjal Desai, MD, University of Minnesota Medical School, Minneapolis, MN, talks on patient selection for autologous stem cell transplantation (autoSCT) in patients with Hodgkin lymphoma (HL). Since most patients with HL are young, have adequate organ function, and have a good performance status, they can be considered for autoSCT. In addition, with the advent of novel checkpoint inhibitor-based salvage regimens, an increasing number of patients achieve a complete response (CR) rate allowing them to undergo autoSCT. Nevertheless, patients who are ineligible for autoSCT due to age and comorbidities remain a significant unmet medical need. This interview took place at the 2023 Transplantation & Cellular Therapy Meetings of ASTCT™ and CIBMTR® held in Orlando, FL.
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Transcript (edited for clarity)
Hodgkin lymphoma patients, the majority of population that gets Hodgkin is a younger population, population of less than 40, mainly at 20, 30 years old. And so recurrent Hodgkin lymphoma, similarly, a lot of patients are younger. So patient selection is not very challenging. The majority of patients have adequate organ function, age performance status to go for autologous stem cell transplant. And as long as you have adequate organ function, you have good performance status, and age is feasible, we can consider them for autologous stem cell transplant...
Hodgkin lymphoma patients, the majority of population that gets Hodgkin is a younger population, population of less than 40, mainly at 20, 30 years old. And so recurrent Hodgkin lymphoma, similarly, a lot of patients are younger. So patient selection is not very challenging. The majority of patients have adequate organ function, age performance status to go for autologous stem cell transplant. And as long as you have adequate organ function, you have good performance status, and age is feasible, we can consider them for autologous stem cell transplant.
Response rate to conventional salvage therapy, that’s another prerequisite to go for autologous stem cell transplant. You have to have chemosensitive disease. And with all older conventional chemotherapy regimen, response rates were still reasonable, but lower. Now, with novel checkpoint inhibitor-based regimens, the response rates before transplant are increasing, so more and more patients are getting into response rates for salvage therapy, and complete response rate is also pretty high. With the most recent trial with Pembro-GVD, they have seen pretty high complete response rates and all the patients were able to successfully bridge to transplant. So, with novel regimens, we are able to get more and more patients into response, complete response, and more and more patients would be able to get to transplant.
Patients who are ineligible for transplant due to age and comorbidities, and Hodgkin’s is a relatively small population, but it’s a population that has huge investigative needs because regimens with curative potentials are lacking for patients with recurrent Hodgkin’s, but they cannot go for transplant either because of the age, typically more than 75 to even more than 80, or they have organ dysfunctions that preclude transplant. Or, in rare cases, salvage failure.
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