Hodgkin Lymphoma

At the 18th ICML in Lugano, Dr Fulvio Massaro from the Institut Jules Bordet, HUBruxelles, highlighted notable presentations on the management of Hodgkin lymphoma,, with the primary focus of interest being the integration of novel immunotherapies in the earlier phases of the disease.

The SWOG S1826 trial investigated the impact of EBV intratumoral positivity and nodular sclerosis histology on Hodgkin lymphoma, revealing that EBV positivity was associated with improved PFS when treated with nivolumab (95%) compared to brentuximab vedotin (72%). Additionally, patients with a non-nodular sclerosis histology had a better prognosis when treated with nivolumab, showing a two-year PFS of 92% compared to 65% in the brentuximab vedotin arm.

In another part of the trial, researchers explored the prognostic value of circulating tumour DNA (ctDNA). They analysed plasma samples collected at baseline, after two cycles of treatment, and at the end of treatment. The study showed that undetectable ctDNA at both time points was correlated with a better prognosis. Specifically, after two cycles, patients with undetectable ctDNA had a two-year PFS of 91%, while those with positive ctDNA had only 62%. At the end of treatment, the difference was even more significant, with undetectable ctDNA patients having a 91% two-year PFS compared to 42% in those with positive ctDNA. The study also noted that patients with rapid reductions in ctDNA levels (classified as fast responders) had significantly better outcomes. This analysis emphasises the potential of ctDNA as a strong prognostic marker and highlights the benefit of early treatment response.

The third abstract focused on an extensive registry study by the EBMT Lymphoma Working Group, analysing outcomes in over 15,000 Hodgkin lymphoma patients treated with autologous or allogeneic stem cell transplantation between 2010 and 2022. The study revealed significant improvements in the two-year PFS of patients undergoing both autologous and allogeneic stem cell transplants in more recent years. For autologous stem cell transplants, the two-year PFS improved from 63% to 73%, while for allogeneic stem cell transplants, it rose from 44% to 62%. These improvements were attributed to factors such as older patient age, better remission rates, and increased use of immunotherapies, including brentuximab vedotin and checkpoint inhibitors. This study highlights the positive impact of integrating immunotherapy into stem cell transplant protocols.