Transplant-Free Strategies Show Promise for Low-Risk Relapsed Hodgkin Lymphoma

Non-transplant salvage therapy for low-risk relapsed/refractory pediatric classical Hodgkin lymphoma (cHL) has demonstrated high rates of progression-free (PFS) and overall survival (OS) at 3-5 years, according to three separate studies. A multicenter European study revealed a 5-year PFS of 89.7% and OS of 97.4% with PET-guided chemotherapy and radiotherapy, results nearly identical to those achieved with standard-of-care autologous stem cell transplant (ASCT).

Two smaller studies further supported these findings, with one showing a 3-year event-free survival and PFS of 87% and 95% without transplantation, and the other reporting second EFS rates of 85.0% and 78.5% at 5 and 8 years, respectively. These studies, published in JAMA Oncology, suggest that ASCT might be reserved for higher-risk patients, offering a less intensive treatment option for those with low-risk relapsed cHL.

Christine Mauz-Körholz, MD, of Justus Liebig University Hospital in Giessen, Germany, highlighted the significance of these findings, stating that PET-guided salvage therapy without transplant achieved "excellent outcomes" in low-risk cHL. The research underscores the potential for de-escalating treatment to transplant-free salvage, based on FDG-PET response and risk-factor analysis.

The DAL-ST-HD-86 trial identified time-to-treatment failure as a dominant prognostic factor, with 10-year PFS rates varying significantly based on the timing of relapse. This trial, along with the EuroNet-PHL-R1 study, which evaluated response-adapted first-line treatment strategies, provides strong evidence supporting the omission of high-dose chemotherapy (HDC)/ASCT without compromising patient outcomes.

Rabi Hanna, MD, and Ilia N. Buhtoiarov, MD, of the Cleveland Clinic, emphasized the importance of selecting patients wisely for transplant-free salvage therapy, noting the need for further research into long-term complications and the development of universally accepted prognostic criteria.

Multinational, U.S. Studies such as CheckMate 744 and AHOD0431 have also contributed to the growing body of evidence supporting risk-directed, transplant-free salvage regimens. These studies highlight the potential for achieving durable remission with less intensive therapies, thereby minimizing the risk of late effects associated with ASCT.

In conclusion, these studies mark significant progress in the treatment of relapsed low-risk Hodgkin lymphoma in children and young adults, offering hope for more targeted and less toxic therapeutic options.