Standard scales, such as ECOG Performance Status, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), and Activities of Daily Living (ADL), are commonly used to stratify patients with acute myeloid leukemia (AML) for intensive chemotherapy (IC). Comprehensive geriatric assessment (CGA) may further identify patients at risk of treatment-related toxicity, but it is underutilized due to time constraints. We aimed to evaluate the predictive relevance of CGA domains in elderly AML patients selected for IC using ECOG, HCT-CI, and ADL. In this prospective study, patients aged 60–75 were eligible for IC if they had ECOG < 2, HCT-CI < 3, and ADL = 6. Regimens included daunorubicin and cytarabine (DA) with or without cladribine (DAC). Additional CGA domains assessed were: Instrumental Activities of Daily Living (IADL), Timed Up-and-Go Test (TUG), Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and Mini Nutritional Assessment (MNA), screening tests Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13). Eighty-five patients (median age: 65) were analyzed. HCT-CI scores of 0–1 were seen in 72

Background: Secondary acute promyelocytic leukemia (sAPL) is a very rare subtype of acute myeloid leukemia that develops following exposure to chemotherapy, radiotherapy, or immunosuppressive agents. The treatment results and survival outcomes of sAPL patients are still not precisely defined. Methods: A search of the Polish Adult Leukemia Group (PALG) database identified 29 cases of sAPL (median age 57 years; 62.1% female) among 437 APL patients (6.7%) diagnosed between 2006 and 2024. Each sAPL case was matched to a de novo APL patient by sex, age, year of diagnosis, and treatment protocol (LPA (Leucemia Promielocítica Aguda) 2005, LPA 2012, or LPA 2017). Results: All sAPL cases occurred following chemo- and/or radiotherapy, most commonly for breast cancer. The sAPL cases demonstrated higher CD15 expression than the de novo APL cases (median 27.6% vs. 7%, p = 0.04). The two groups exhibited comparable complete remission rates (82.8% sAPL vs. 75.9% de novo; p = 0.75) and early mortality rates (17.2% vs. 20.7%, p = 1.0). However, relapse-free survival was significantly shorter in sAPL (median 94.7 months vs. not reached; HR 7.23, 95% CI 1.63–32.02, p = 0.030), whereas overall survival did not differ significantly between groups. Multivariate analysis identified Eastern Cooperative Oncology Group performance status ≥3 and CD15 expression > 20% as independent predictors of inferior survival. Conclusions: These findings suggest that sAPL shares many clinical features with de novo APL but carries a higher risk of relapse, highlighting the need for further prospective studies and the potential implementation of tailored therapeutic strategies.

We compared the presence of additional chromosomal abnormalities (ACAs, n = 345) with a referent group with no ACAs (n = 169) (noACAs) in patients with Ph+ ALL receiving TKI before transplantation. The groups did not differ significantly in age, gender, or interval from diagnosis to transplantation. More patients with ACAs received PB grafts (86.4% vs. 78.1%, p = 0.03), while more patients in the noACAs group received myeloablative conditioning (87% vs. 75.9%, p = 0.003). Day 30 ANC (≥109/L) was 97.9% vs. 98.2%, and day 60 platelet count (≥20 × 109/L) was 93.9% vs. 95.5%. Day 100 acute GVHD grades II-IV was 26.4% vs. 31%, and of grades III-IV was 8.6% vs. 9.7%. 4-year chronic GVHD was 40.5% vs. 39.9%, and the proportion of extensive chronic GVHD was 19.3% vs. 20.1%. 4-year NRM was 13.1% vs. 13.5%, and 4-year RI was 19.2% vs. 21.1%; 4-year LFS and OS were 67.7% vs. 65.4% and 76.3% vs. 78.5%. 4-year GRFS was 48.5% vs. 45%, respectively. In multivariable analysis, having ACAs and the number of ACAs did not significantly affect transplant outcomes. Administration of a TKI upfront, followed by transplantation, may overcome the poor prognostic influence of ACAs in Ph+ ALL.

For patients with high-risk acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (HCT) remains standard of care. In the setting of an HLA-matched unrelated donor HCT, in vivo T-cell depletion (TCD) for prophylaxis of graft versus host disease (GVHD) relies on anti-thymocyte globulin (ATG) in Europe and alemtuzumab in the UK. In a retrospective study from the EBMT registry, we pair-matched 90 ALL patients aged ≥40 years transplanted in CR1 according to age (median 56 years) and ALL subtype (37.8% Ph-negative B-ALL, 46.7% Ph-positive B-ALL, 15.6% T-ALL). Reduced-intensity conditioning included fludarabine/melphalan (94.4%) in the alemtuzumab and fludarabine/busulfan (36.7%), fludarabine/total body irradiation (21.1%), fludarabine/melphalan (14.4%) and thiotepa/busulfan/fludarabine (13.3%) in the ATG group. Two-year leukemia-free and overall survival were similar between groups (Alemtuzumab: 56.4% vs ATG: 50.7%, HR 0.82, p = 0.34, and 62.7% vs 62.9%, HR 0.91, p = 0.67), as were cumulative incidence of relapse (23.7% vs 23.9%, HR 0.89, p = 0.69) and non-relapse mortality (19.9% vs 25.4%, HR 0.75, p = 0.32), resulting in similar GVHD- and relapse-free survival (GRFS) of 48.9% vs 42.1%, HR 0.8, p = 0.24. With GVHD and infections as main reasons for death in both groups, we conclude that both IS strategies are both safe for RIC HCT of these ALL patients.

Hematopoietic stem cell transplantation (HSCT) is an intensive and physically demanding treatment used in patients with hematological malignancies and is associated with substantial psychological burden. This study aimed to examine the temporal trajectories of depressive and anxiety symptoms during hospitalization for HSCT. A total of 169 patients undergoing HSCT completed the hospital anxiety and depression scale (HADS) at four time points: at hospital admission (T1), one day before transplantation (T2), six days post-transplantation (T3), and at discharge (T4). Changes over time were analyzed using repeated-measures analysis of variance. The proportion of patients with moderate-to-severe depressive symptoms increased from 14.2% at admission to 42.6% six days after HSCT and remained elevated at discharge (33.2%). Anxiety symptom severity remained relatively stable across hospitalization. A significant effect of time was observed for both depressive and anxiety symptoms. Depressive symptoms increased during hospitalization, reaching their highest levels six days after transplantation (T3), followed by partial improvement at discharge; however, symptom severity remained higher than at admission. The proportion of patients presenting moderate and severe depressive symptoms also increased over the course of hospitalization. In contrast, anxiety symptoms remained relatively stable from admission to the early post-transplant phase and decreased significantly at discharge. Patients with high baseline levels of depressive or anxiety symptoms continued to report elevated symptom severity throughout hospitalization. Depression and anxiety follow distinct temporal patterns during HSCT hospitalization. These findings highlight the need for systematic psychological monitoring and phase-specific supportive interventions tailored to symptom type and baseline emotional burden.

Tuberculosis (TB) is an infectious complication of hematopoietic cell transplantation (HCT). There is a paucity of data on TB after HCT. Here we present the data from a low/low-intermediate TB-burden country. This was a Retrospective analysis of adult patients who developed TB after HCT. Seventeen patients were identified, 9 (52.9%) females, the median age at TB 44 years. Five (29.4%) patients underwent auto-HCT, 12 (70.6%) allo-HCT, translating into the relative frequency of TB of 0.171% for allo-HCT, and 0.063% for auto-HCT. The median time from HCT to TB was 431 days (range, 5-973). All patients had pulmonary TB. Bacteriologically confirmed TB was diagnosed in 13 (76.5%) patients; drug susceptibility testing was performed in 3/13 (23.1%). The median duration of treatment was 6 months. Twelve out of 13 evaluable patients (92.3%) obtained treatment success. With a median follow-up of 48 months (95%CI 19-95) 1-year cumulative incidence of TB-associated death was 6.7% (95%CI 0.9-40.8%). To conclude TB is a very rare infectious complication of HCT. Most frequently TB develops late after HCT. The primary site involved is the lung with no extrapulmonary TB identified in the current analysis. TB can still result in the death of the affected patient.

This phase 2 trial evaluated the safety and efficacy of acalabrutinib used to reduce tumor burden before allogeneic hematopoietic cell transplantation (allo-HCT) and as a maintenance therapy after transplantation in patients with relapsed/refractory mantle cell lymphoma (R/R MCL). Patients were treated with acalabrutinib 100 mg BID for 3–6 months. Those achieving complete or partial response (CR, PR) were referred for allo-HCT. Acalabrutinib was restarted 30–90 days after allo-HCT and administered for the subsequent 9 months. The remaining patients continued acalabrutinib until progression or unacceptable toxicity. Out of the 28 included patients, 16 subjects (57

Cytomegalovirus (CMV) infection remains a significant cause of morbidity and mortality due to the compromised immune system after hematopoietic stem cell transplantation (HSCT). Natural killer (NK) cells are pivotal in the immune response following HSCT, as these cells regenerate early and play a crucial role in detecting and eliminating infections. In the present study, we analyzed expression and single nucleotide polymorphisms (SNPs) of genes coding for NK cell Natural Cytotoxicity Receptors (NCRs). Expression was studied on the mRNA level and on the protein level, using flow cytometry to examine NCR-positive NK cell populations. Our study revealed significant higher expression of NCR1 and NCR3 in HSCT recipients with CMV infection compared to those without complications. Additionally, expression of both receptors correlated with expression of IFN-γ. Changes over time after HSCT were observed in the proportion of NCR1+ NK cells. SNPs genotyping identified associations of NCR1 rs1433097 and NCR3 rs11575836 genotypes with increased risk of CMV infection, as well as of NCR3 rs11575836 with post-HSCT overall survival. These results underscore the crucial role of NCRs in the prevention of infection and the development of post-HSCT complications, highlighting their potential as therapeutic targets to improve transplant outcomes.

BACKGROUND:Autologous haematopoietic cell transplantation (auto-HCT) is the recommended treatment for chemosensitive relapsed Hodgkin lymphoma, while allogeneic haematopoietic cell transplantation (allo-HCT) is indicated for patients who had unsuccessful auto-HCT. The introduction of novel therapeutic agents, alongside advances in donor selection, conditioning regimens, and graft-versus-host disease prophylaxis, might improve post-transplantation outcomes, however supporting data remain limited. We aimed to evaluate changes in post-transplantation outcomes over the period 2010-22, and to identify predictors of these outcomes. METHODS:We conducted a retrospective, registry-based cohort study of patients aged 18 years or older with relapsed or refractory classical Hodgkin lymphoma undergoing first auto-HCT or first allo-HCT between Jan 1, 2010, and Dec 31, 2022, registered with the European Society for Blood and Marrow Transplantation (EBMT), with data from more than 600 transplantation centres, across 53 countries, reporting all HCTs and yearly follow-ups. Patients who received allo-HCT for relapse after auto-HCT were included but tandem transplantations were excluded. For allo-HCT, we included patients who received grafts from matched related donors, mismatched related donors, and unrelated donors. The primary endpoints were overall survival and progression-free survival, which were assessed with the Kaplan-Meier method at 2 years and 5 years after HCT. Multivariate analyses were performed using the Cox proportional-hazards regression model to identify predictive factors. FINDINGS:We identified 22 047 patients who received a first transplantation for relapsed or refractory Hodgkin lymphoma, after excluding 1324 patients with missing follow-up data and 1225 patients with nodular lymphocyte predominant Hodgkin lymphoma, 19 498 patients were retained: 15 648 received auto-HCT (6772 [43%] were female and 8839 [57%] were male, data were missing for 37 patients); median age at HCT was 35 years [IQR 27-47]; median follow-up was 2·4 years [IQR 2·3-2·5]), and 3850 received allo-HCT (1572 [41%] female and 2273 [59%] were male, data were missing for five patients; median age at HCT 32 years [IQR 26-42]; median follow-up was 3·9 years [IQR 3·8-4·1]). For auto-HCT, from years 2010-14 to years 2019-22, the 2-year progression-free survival increased from 63% (95% CI 62-65) to 73% (71-74) and overall survival increased from 85% (95% CI 84-86) to 93% (91-94). Partial response (hazard ratio [HR] 1·92 [95% CI 1·74-2·11]) or stable or progressive disease (2·45 [2·17-2·76]) at transplantation negatively affected progression-free survival. For allo-HCT, from years 2010-14 to years 2019-22, the 2-year progression-free survival, and overall survival, increased from 44% (95% CI 41-46) to 62% (58-66), and from 66% (63-68) to 72% (68-75), respectively. Partial response (HR 1·58 [95% CI 1·39-1·78]) or stable/progressive disease (2·28 [2·02-2·58]) at transplantation negatively affected progression-free survival. INTERPRETATION:To our knowledge, this is the largest study on HCT for Hodgkin lymphoma in recent years, and our findings that outcomes after auto-HCT and allo-HCT improved over time provide relevant information that could set the basis for prospective trials or additional studies. FUNDING:None.

There are very limited data on treosulfan (Treo)-based conditioning before allogeneic hematopoietic stem cell transplantation (alloHSCT) in acute lymphoblastic leukemia. We aimed to compare fludarabine with Treo (FluTreo) or total body irradiation (FluTBI) in this setting. The final matched-pair analysis included ALL patients transplanted in complete remission after FluTreo (n = 153) or FluTBI (n = 431). The median patient age was 56.5 and 54.1 years, respectively. The allograft was derived from an unrelated (54.2% in FluTreo and 52% FluTBI group), matched sibling (30.7% and 32.5%) or haploidentical donor (15% and 15.5%). The incidence of acute graft-versus-host disease (GVHD) grade II-IV was 26.6% in the FluTreo and 30% in the FluTBI group (p = 0.43). The 2-year incidence of chronic GVHD was 33.5% and 40.7%, respectively (p = 0.23). The 2-year incidence of relapse and non-relapse mortality was 28.1% and 25.6% in the FluTreo and 25.1% and 20.4%, respectively, in the FluTBI group (p = 0.15 and p = 0.38). Leukemia-free survival and overall survival was 46.2% and 55% in the FluTreo and 54.5% and 61.3%, respectively, in the FluTBI group (p = 0.1 and p = 0.22). GVHD-free and relapse-free survival was 33.7% and 40.8%, respectively, in FluTreo and FluTBI patients (p = 0.06). In conclusion, there were no significant differences in transplant outcomes between the studied groups.

Background: (Ph+) is the most common cytogenetic abnormality in adults with ALL. Additional chromosomal abnormalities (ACA) are found in about 60%-70% of patients (pts) with Ph+ ALL. Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment paradigm in Ph+ ALL. Allogeneic transplantation (HSCT) is still the standard of care in Ph+ ALL-eligible pts in CR1. Data are conflicting regarding the impact of ACA and complex karyotype (CK) on outcomes of Ph+ ALL pts undergoing HSCT while in CR1 in the TKI era. Methods:The study aimed to assess the impact of ACA and CK on HSCT outcomes of Ph+ ALL pts that received a TKI and underwent first HSCT while in CR1 between 2010-2022. Pts needed to have full karyotyping data, including Ph as an abnormality. Outcomes were LFS, OS, GVHD-free relapse-free survival (GRFS), RI, and NRM. The impact of ACA was evaluated by comparing the presence of ACA (1 ACA, 2-3 ACA, or ≥4 ACA) to the referent group with no ACA (noACA). Results: 514 Ph+ pts were included: with ACA (n=345); without ACA (n=169). Of the 345 pts with ACA, 109 had 1 ACA, 100 had 2-3 ACA, and 136 had > 4 ACA. 210 pts had at least one monosomy, most frequently monosomy 7 (n=63). 101 pts had at least one trisomy. Twelve pts had 11q23 translocations. IKZF1 mutations were observed in 8.7% and 7.7% of pts with and without ACA, respectively. The presence of ACA was associated with a higher rate of MRD-negativity pre HSCT (56.2% vs. 46.5%, p=0.04). Median follow-up was 4.2 years (95% CI, 3.9-4.7). Median year of transplant was 2018 IQR, 2015-2020), with no significant difference between the groups (p=0.27). Median age was 42.6 years (IQR, 31.7-53.5), and 54.5% were male. The groups (ACA vs. noACA) did not differ significantly in terms of age, gender, and interval from diagnosis to HSCT. In the ACA and noACA groups, donors were matched siblings in 32.5% vs. 28.4%, unrelated in 37.1% vs. 27.2%, or haploidentical in 28.7% vs. 40.2%, respectively. More pts with ACA received PB grafts compared to the noACA group (86.4% vs. 78.1%, p=0.03). Pt CMV seropositivity was more frequent in the ACA than in the noACA group (70.5% vs. 57.2%, p=0.009). The use of myeloablative conditioning was more frequent in noACA than in ACA pts (87% vs. 75.9%, p=0.003), with TBI-based being the most frequent conditioning in both groups (51.9% vs. 40.2%). Post-transplant cyclophosphamide was administered to 12.9% vs. 14.8%, respectively (p=0.55). Day 30 absolute neutrophil count (>109/L) was 97.9 % vs. 98.2 % and day 60 platelet count (>20x109/L) was 93.9 % vs. 95.5%, for the ACA and noACA groups, respectively. The incidence of day 100 acute (a) GVHD grades II-IV was 26.4% vs. 31% and of grades; III-IV was 8.6% vs. 9.7%, respectively. 4-year incidence of chronic (c) GVHD was 40.5 % vs. 39.9 % and of extensive cGVHD was 19.3% vs. 20.1 %. 4-year NRM was 13.1 % vs. 13. 5%, and 4-year RI was 19.2 % vs. 21.1 %, respectively. The 4-year LFS and overall survival rates were 67.7% vs. 65.4 % and 76.3% vs. 78.5%, respectively. 4-year GRFS was 48.5% vs. 45%, respectively. In multivariate analysis, having ACA and the number of ACAs did not affect transplant outcomes significantly. Compared to noACA, hazard ratios for LFS were 0.93, 0.90, and 1.06 for 1 ACA, 2-3 ACA, and ≥4 ACA, respectively. Year of HSCT and age were poor prognostic factors for NRM, LFS, and OS. Year of HSCT was also a poor prognostic factor for RI, GRFS, and total and extensive cGVHD. Greater than 6 months from diagnosis to HSCT was a negative prognostic factor for NRM, LFS, OS, GRFS, and aGVHD II-IV. MRD-positivity pre-HSCT was a poor prognostic factor for LFS, OS, and NRM. A mismatched related donor was associated with lower RI and higher NRM. An unrelated donor was associated with higher NRM and aGVHD II-IV, while reduced intensity conditioning was associated with a lower incidence of aGVHD II-IV. Female-to-male donor was associated with a higher incidence of total cGVHD. Conclusions: In this registry-based retrospective analysis of Ph+ ALL pts receiving a TKI and subsequent HSCT, no significant differences were observed in transplantation outcomes between pts with or without ACA, including those with additional CK. Notably, achieving MRD-negativity pre HSCT was significantly higher in pts with ACA. These data may indicate that the administration of a TKI upfront, followed by HSCT, may overcome the poor prognosis influence of the ACA, including CK in Ph+ ALL.

Background: The use of tyrosine kinase inhibitors (TKIs) has improved the prognosis of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). The current standard of care for fit patients involves combining TKIs with chemotherapy. Allogeneic hematopoietic cell transplantation (allo-HCT) remains a key component in the management of Ph+ ALL, particularly in patients with delayed measurable residual disease (MRD) clearance. Multiple TKIs are used in frontline therapy, including imatinib and more potent second- and third-generation TKIs. Early molecular remission is more frequently achieved with newer generation TKIs, and predicts better long-term outcomes. However, the impact of different TKIs used before and after allo-HCT on long-term clinical outcomes in Ph+ ALL remains to be explored. This study aimed to evaluate clinical outcomes associated with various TKIs used in pre-allo-HCT and the use of post-transplant TKI maintenance in patients with Ph+ ALL transplanted in first complete remission (CR1). Methods: This was a retrospective, registry-based analysis conducted using data from the European Society for Blood and Marrow Transplantation, approved by the Acute Leukemia Working Party. Adult patients (≥18 years) diagnosed with Ph+ ALL, treated with TKI-based induction therapy, and who underwent allo-HCT in CR1 regardless of MRD between 2010 and 2022 were included. The use of a prophylactic TKI was evaluated as a time dependent covariate in an adjusted Cox model. Results: A total of 958 patients were analyzed (median age: 44 years [range 18–76]; 54% male). The median time from diagnosis to transplant was 5.5 months. At the time of allo-HCT, 61% were MRD-undetectable, assessed by PCR (75%) or flow cytometry (21%). Donor types included matched related (37%), haploidentical (21%), and matched unrelated (26%). Peripheral blood stem cells were used in 84% of cases, with 79% receiving myeloablative conditioning, and 51% receiving total body irradiation. TKI use prior to transplant included imatinib (N=612, 64%), dasatinib (N=210, 22%), nilotinib (N= 96, 10%), and ponatinib (N=40, 4%). Ponatinib was used more recently (median transplant year: 2020), compared to second-generation TKIs (2018) and imatinib (2016) (p<0.001). Patients receiving ponatinib were older (median age: 51 vs. 44 vs. 45 years for ponatinib, second-generation TKIs, and imatinib, respectively; p<0.001). MAC was more frequently administered to patients treated with second-generation TKIs (86%) compared to imatinib (74%) and ponatinib (75%) (p<0.001). Other baseline characteristics, including MRD status, were balanced across groups. The 3-year post-allo-HCT prophylactic TKI incidence was 31% including imatinib, dasatinib, nilotinib and ponatinib, in 51%, 28%, 16%, and 3% respectively. After a median follow-up of 5.2 years (95%CI: 4.9-5.7), 3-year overall survival (OS) was 73% (95% CI: 70–76), and the OS with imatinib was 70%, dasatinib 78%, nilotinib 81%, and ponatinib 84%. Three-year leukemia-free survival (LFS) was 62% (95% CI: 59–65): imatinib 57%, dasatinib 69%, nilotinib 75%, ponatinib 70%. The 3-year relapse incidence was 21%: imatinib 24%, dasatinib 14%, nilotinib 13%, ponatinib 22%. Graft-versus-host disease-free, relapse-free survival was 47%: imatinib 43%, dasatinib 53%, nilotinib 51%, ponatinib 65%. Multivariable analysis showed that use of pre-transplant TKIs other than imatinib was independently associated with improved LFS (hazard ratio [HR]: 0.75; 95% CI: 0.58–0.97; p=0.03). Increasing age negatively affected both LFS (HR: 1.06; p=0.008) and OS (HR: 1.12; p<0.001). Use of a prophylactic post-allo-HCT TKI was associated with significantly improved LFS (HR: 0.62; 95% CI: 0.47–0.81) and OS (HR: 0.50; 95% CI: 0.36–0.70), both p<0.001. There was no significant interaction effect on OS between MRD status at HCT and prophylactic TKI use. Donor type, TBI use, and pre-transplant MRD status were not significant predictors of survival outcomes. Conclusion: In this large, multicenter cohort of patients with Ph+ ALL undergoing allo-HCT in CR1, the use of second- and third-generation TKIs during induction was associated with superior survival outcomes compared to imatinib. Post-transplant TKI prophylaxis significantly improved LFS and OS, regardless of pre-transplant MRD status. These findings support the incorporation of newer TKIs and prophylactic strategies in the transplant setting to optimize long-term outcomes in Ph+ ALL.

ABSTRACT:Checkpoint inhibitors (CPIs) have shown remarkable efficacy in Hodgkin lymphoma (HL), and are now used routinely. While allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative option for HL, there are concerns prior CPIs may exacerbate post-allo-HCT complications, particularly graft-versus-host disease (GVHD), and lead to worse outcomes. Given the relative paucity of data, we performed a Center for International Blood and Marrow Transplant Research/European Society for Blood and Marrow Transplantation study to examine the impact of prior CPIs in allo-HCT. We included 2186 adult patients aged >18 years who received a first allo-HCT using a matched related, unrelated, or haploidentical donor from 2008 to 2023. Twenty-seven percent of patients received prior CPIs. GVHD prophylaxis was posttransplant cyclophosphamide (PTCy) in 55.8% of patients in the CPI cohort, and 35% in the non-CPI cohort. Median follow-up among survivors was longer for the non-CPI (39 months) than CPI cohort (16.5 months). In multivariate analysis, prior CPI exposure did not affect overall survival (OS) or nonrelapse mortality, but resulted in improved progression-free survival (non-CPI vs CPI hazard ratio [HR], 0.81; 0.67-0.98; P = .03) and lower relapse incidence (HR, 0.58; 0.45-0.76; P < 001). While grade 2 to 4 (HR, 1.26; 1.04-1.53; P = .02) and 3 to 4 (HR, 1.41; 1.04-1.92; P = .03) acute GVHD (aGVHD) were increased, differences in chronic GVHD (cGVHD) were not significant. PTCy-based GVHD prophylaxis resulted in improved OS, lower grade 2 to 4 aGVHD, and cGVHD in patients with prior CPI exposure. In summary, allo-HCT should still be considered a curative option for patients with HL in the era of CPIs.