Key Points : - CPI in salvage chemo and TLI with ASCT yields 96.4% relapse-free survival at 3 years in relapsed/refractory Hodgkin lymphoma. - Although not statistically significant, TLI and checkpoint inhibitors may increase ES risk, highlighting early detection and steroids. The treatment landscape for classic Hodgkin lymphoma (cHL) has significantly advanced with the advent of immune checkpoint inhibitors (CPIs). Combining CPIs with chemotherapy in the relapsed or refractory setting has increased complete remission rates, resulting in more patients undergoing consolidative autologous stem cell transplantation (ASCT). Total lymphoid irradiation (TLI) containing conditioning regimens has been a standard approach at our institution and has previously yielded impressive results. Here, we retrospectively report the outcomes of patients who underwent both CPI during and TLI-based condition during ASCT. We report on 47 patients with cHL who underwent ASCT between 2018 and 2023 in order to describe outcomes including incidence of engraftment syndrome (ES). We found that 68.1% received CPI during salvage therapy (3-year relapse-free survival RFS of 92.7%), and 68.1% underwent TLI-based conditioning (3-year RFS of 96.4%). CPI exposure was associated with a higher incidence of ES (53.1% vs. 26.7%), although this was not statistically significant due to the small sample size. TLI-based conditioning significantly increased the risk of ES but was linked to lower relapse rates. Overall, while CPI in salvage regimens remains safe with vigilant ES management, TLI-based conditioning continues to deliver favorable outcomes despite the higher ES risk.
Odetola et al. (2026) studied this question.