Checkpoint Inhibitors and the Changing Face of the Relapsed/Refractory Classical Hodgkin Lymphoma Pathway

Area of Science:

• Hematology
• Oncology
• Immunotherapy

Background:

• Classical Hodgkin lymphoma (cHL) relapses often require novel therapeutic strategies.
• Checkpoint inhibitors (CPIs) targeting PD1 have demonstrated significant activity in relapsed/refractory cHL.
• Current clinical practice raises questions regarding the optimal integration of CPIs.

Purpose of the Study:

• To review the current use of CPIs in various relapsed/refractory settings for cHL.
• To define the role of CPIs in the treatment landscape of cHL.
• To identify key areas for future research in CPI therapy for cHL.

Main Methods:

• Review of recent clinical studies and literature on CPIs in cHL.
• Analysis of CPI efficacy in different treatment scenarios (first relapse, salvage, maintenance).
• Discussion of immune-related adverse events and strategies to overcome resistance.

Main Results:

• CPIs show efficacy as first-line salvage therapy, pre- and post-stem cell transplant (ASCT and alloSCT), and as maintenance therapy.
• Peri-alloSCT use of CPIs requires careful monitoring due to association with hyperacute graft-versus-host disease.
• Newer CPIs and resistance-overcoming strategies are under investigation, with increasing use earlier in the treatment pathway.

Conclusions:

• CPIs are a valuable tool in managing relapsed/refractory cHL across multiple settings.
• Optimal integration requires careful consideration of efficacy, safety (especially peri-transplant), and emerging strategies.
• Randomized controlled trials are essential to establish definitive optimal positioning and long-term outcomes of CPIs in cHL.