Pembrolizumab or nivolumab (alone or with chemotherapy)

In a phase II trial of 37 patients with relapsed or refractory disease, patients received three cycles of pembrolizumab with two cycles of ICE chemotherapy (ifosfamide, carboplatin, and etoposide) every 21 days prior to autologous SCT.[6][Level of evidence C3]

In a phase II trial of 37 patients with relapsed or refractory disease, patients received three cycles of pembrolizumab with two cycles of ICE chemotherapy (ifosfamide, carboplatin, and etoposide) every 21 days prior to autologous SCT.[6][Level of evidence C3]

The complete response rate was 86.5% (95% confidence interval [CI], 71.2%–95.5%), and the overall response rate was 97.3%. There was no impairment in stem cell mobilization.

A phase II trial included 39 patients with transplant-eligible relapsed or refractory disease. Patients received pembrolizumab with GVD chemotherapy (gemcitabine, vinorelbine, and liposomal doxorubicin).[7]

A phase II trial included 39 patients with transplant-eligible relapsed or refractory disease. Patients received pembrolizumab with GVD chemotherapy (gemcitabine, vinorelbine, and liposomal doxorubicin).[7]

With a median follow-up of 13.5 months, the overall response rate was 100%, and the complete response rate was 95%.[7][Level of evidence C3]

A phase II trial included 39 patients with transplant-eligible relapsed or refractory disease. Patients received pembrolizumab with GVD chemotherapy (gemcitabine, vinorelbine, and liposomal doxorubicin).[7]

Thirty-six patients (35%) proceeded to autologous SCT consolidation.

A prospective randomized trial included 304 patients with relapsed or refractory disease who were ineligible for or had a relapse after autologous SCT. Patients were assigned to receive either pembrolizumab or brentuximab vedotin.[8]

A prospective randomized trial included 304 patients with relapsed or refractory disease who were ineligible for or had a relapse after autologous SCT. Patients were assigned to receive either pembrolizumab or brentuximab vedotin.[8]

With a median follow-up of 25.7 months, the median progression-free survival (PFS) for patients who received pembrolizumab was 13.2 months (95% CI, 10.9–19.4) versus 8.3 months (95% CI, 5.7–8.8) for patients who received brentuximab vedotin (hazard ratio [HR], 0.65; 95% CI, 0.48–0.88; P = .0027).[8][Level of evidence B1]

A prospective randomized trial included 304 patients with relapsed or refractory disease who were ineligible for or had a relapse after autologous SCT. Patients were assigned to receive either pembrolizumab or brentuximab vedotin.[8]

Serious treatment-related adverse events occurred in 16% of patients who received pembrolizumab and 11% of patients who received brentuximab vedotin.

Studies of patients with relapsed HL treated with pembrolizumab reported the following:[9,10][Level of evidence C3]

Studies of patients with relapsed HL treated with pembrolizumab reported the following:[9,10][Level of evidence C3]

The overall response rate was 64% to 74%, with a complete response rate of 22.4% (95% CI, 6.9%–28.6%).

Studies of patients with relapsed HL treated with pembrolizumab reported the following:[9,10][Level of evidence C3]

Pembrolizumab was well tolerated by patients and can be used to achieve a clinical complete remission before autologous or allogeneic SCT.

Studies of patients with relapsed HL treated with pembrolizumab reported the following:[9,10][Level of evidence C3]

The U.S. Food and Drug Administration (FDA) approved pembrolizumab for use in cases of refractory disease or relapse after three or more lines of therapy.

Studies of patients with relapsed HL treated with nivolumab reported the following:[11-13][Level of evidence C3]

Studies of patients with relapsed HL treated with nivolumab reported the following:[11-13][Level of evidence C3]

The overall response rate was 65% to 87% and the complete response rate was 16% to 28%, with response durations usually exceeding 1 year for patients with heavily pretreated, relapsed disease.

Studies of patients with relapsed HL treated with nivolumab reported the following:[11-13][Level of evidence C3]

Nivolumab was well tolerated by patients and can be used to achieve a clinical complete remission before autologous or allogeneic SCT.

Studies of patients with relapsed HL treated with nivolumab reported the following:[11-13][Level of evidence C3]

The FDA approved nivolumab for use after both relapse from SCT and previous exposure to brentuximab vedotin. Nivolumab is also approved if the patient has received three different previous treatments, including SCT.

In a phase II trial, nivolumab was given for 3 months. Patients who achieved a complete response proceeded to autologous SCT, while patients with disease in partial response or less received NICE (nivolumab, ifosfamide, carboplatin, and etoposide).[14]

In a phase II trial, nivolumab was given for 3 months. Patients who achieved a complete response proceeded to autologous SCT, while patients with disease in partial response or less received NICE (nivolumab, ifosfamide, carboplatin, and etoposide).[14]

Nivolumab induction was given to 34 patients, and 9 patients needed NICE because the complete response rate was 71% for nivolumab. After all therapy, the overall response rate was 93%, and the complete response rate was 91%. The 2-year PFS rate was 72%, and the 2-year OS rate was 95%.[14][Level of evidence C3]