Patients with relapsed or refractory Hodgkin lymphoma (HL) may have more upfront options than previously thought. According to Philippe Armand, MD, PhD, chief, Division of Lymphoma, Dana-Farber Cancer Institute, new research highlights exciting developments in the use of checkpoint inhibition (CPI) in HL salvage therapy.
At the 2nd Annual HemOnc Pulse Live, held on May 2–3, 2025, in Austin, Texas, Dr. Armand led a discussion of new treatment options in the management of relapsed/refractory Hodgkin’s lymphoma. According to Dr. Armand, incorporating CPI as a part of second-line salvage therapy rather than just as consolidation provides clear benefits to progression-free survival (PFS) rates for patients.1
An Evolution in Salvage Therapy
In the historical paradigm, CPI would only be used in consolidation, following the administration of chemotherapy with the intention of proceeding to autologous stem cell transplants (ASCT). Now, Dr. Armand argues all of that is about to change, with evidence showing that CPI has clear benefits as a major aspect of salvage therapy, potentially helping to avoid harsher transplants or therapies.
According to findings in a 2023 multicenter, retrospective study (36629030) of approximately a thousand patients who underwent ASCT, event-free survival was significantly higher for patients who received checkpoint inhibition as part of their salvage therapy compared to those who received BV, BV + chemotherapy, or chemotherapy alone. CPI-based treatment maintained a PFS rate of around 0.8 over a 60-month range, while other treatments managed only around 0.5, or as low as 0.2 in the case of BV alone.2
Dr. Philippe Armand giving a presentation during the 2nd Annual HemOnc Pulse Live.
Dr. Armand explained: “There have been a number of studies looking at checkpoint not as consolidation but as part of salvage therapy”, noting “phenomenally high” response rates across all these studies.1 To support this, Armand showcased a range of studies that observed an Objective Response Rate of approximately 90%-100%. Additionally, a Complete Response Rate of approximately 85%-95% occurred within a 2-year PFS of 70%-95%.1
The Value of Transplants
Amidst these exciting results, questions remain regarding the optimal placement of CPI as well as the role of autologous transplants in salvage treatment for
R/R HL. In the aftermath of chemotherapy, many patients may be looking for options besides transplants, and Dr. Armand isn’t wholly comfortable disregarding it.
“The hard thing is this is a lot of interlocking pieces – because everything we change in one place affects what happens in another,” Dr. Armand cautioned, “The level of evidence we have for making recommendations or for making clinical choices is quite variable.”
Dr. Armand mentioned several studies, both in pediatrics and using German data, where specially selected patients who did not receive ASCT still maintained very high PFS levels, around 90-95%.In select cases, CPI and chemotherapy may be powerful enough to eliminate the need for ASCT altogether.
The question remains: “When you have results as good as the ones that we showed you, do we need to transplant patients anymore?” For Dr. Armand, that answer is still yes. This is due to established risk stratification schemes not being applicable to these new treatments, as risk factors for survival after ASCT were identified prior to CPI integration.3 As exciting as the potential of CPI in salvage is, Armand believes that ASCT may be the driver of such excellent outcomes, rather than something to be avoided.1
With the evidence presented, Dr. Armand hopes he has convinced his colleagues of the magnitude of the benefit of CPI in second-line therapy; beyond this, it’d send patients to more aggressive treatments that he’d prefer to avoid. Armand concluded: “So, this is your last chance to cure patients – that’s really important”.
References:
- Armand P, et al. Controversies & Unanswered Qs in R/R Hodgkin Lymphoma. Presented at: TheHemOnc Pulse Live; May 2-3, 2025; Austin, TX
- Desai SH, et al. Am J Hematol. 2023;98(3):464-471. doi:1002/ajh.26827
- Bröckelmann PJ, et al. Ann Oncol. 2017;28(6):1352-1358. doi:1093/annonc/mdx072
© 2025 Mashup Media, LLC, a Formedics Property. All Rights Reserved.