EBMT 2022 | Transplantation in Hodgkin lymphoma in the context of targeted immunotherapy

Stem cell transplantation or the indication for stem cell transplantation in patients with Hodgkin’s lymphoma have remained quite stable over the last few years. So, basically, we are considering autologous transplant for those patients that are primary refractory or that are in the first relapse after first-line conventional chemotherapy.

Over the last few years, we have been able to improve the results of autologous stem cell transplantation, basically, by increasing the percentage of patients that achieve a metabolic complete remission with the first-line salvage chemotherapy, and with the use of consolidation strategies after autologous stem transplantation in those patients that are at a high risk of relapse. Maybe in the future, we will be able to avoid autologous stem cell transplantation in patients with primary refractory or with relapsed disease that achieve a metabolic complete remission with salvage strategies by substituting autologous stem cell transplantation by one or the other of the two new drugs that we have nowadays, or maybe not-so-new drugs, brentuximab vedotin and checkpoint inhibitors.

If we talk about allogeneic stem cell transplant, allo-transplant have been, basically, dedicated to those patients that relapse after an autologous stem cell transplantation, and at least for the time being, is the only curative strategy that we have for these patients. But, in this specific setting, we have seen, over the last few years, the introduction of newer treatments, as I have mentioned before, brentuximab vedotin and checkpoint inhibitors, are very effective treatments with a lower toxicity or a better toxicity profile in comparison with allogeneic stem cell transplantation. And this has made the numbers of allogeneic stem cell transplantations decrease over time and also move the allogeneic stem cell transplantation indication to later phases of the disease. Although, we know that the combination of checkpoint inhibitors, and then an allogeneic stem cell transplantation to consolidate the results of checkpoint inhibitors, are able to give, really, very interesting results.