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Many studies have demonstrated that checkpoint inhibition with monoclonal antibodies targeting the programmed death 1 (PD1) receptor are safe and efficacious in patients with relapsed and refractory classic Hodgkin lymphoma (cHL). However, use of checkpoint inhibitors prior to transplantation has been shown to increase the risk of developing GvHD. Posttransplant cyclophosphamide (PTCy) as a prophylaxis for graft-versus-host disease (GvHD) is used in patients who have undergone haploidentical stem cell transplantation (haplo-SCT), and it has been recently shown to be effective for patients receiving PD1 blockade therapy.1,2
In a retrospective study, Chiara De Philippis, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, IT, and colleagues aimed to analyze the effect of checkpoint inhibitors (CPIs) before haplo-SCT with PTCy prophylaxis in patients with cHL. The study was recently published in the journal Blood Advances.1 Watch a video of Chiara De Phillipis discussing the same topic here.
Table 1. Patient characteristics1
auto-SCT, autologous stem cell transplant; BM, bone marrow; CMV, cytomegalovirus; CPI, checkpoint inhibitor; CR, complete remission; HCT-CI, hematopoietic cell transplantation-comorbidity index; PBSC, peripheral blood stem cell; PD, progressive disease; PR, partial remission; SD, stable disease |
||||
Characteristic |
All patients (N = 59) |
No-CPI (n = 30) |
CPI (n = 29) |
p value |
---|---|---|---|---|
Median age, years (range) |
30 (19–64) |
31 (19–64) |
30 (21–61) |
0.896 |
Previous auto-SCT, % |
83 |
90 |
76 |
0.181 |
Previous lines of therapy (range) |
5 (2–11) |
4 (2–11) |
6 (3–9) |
< 0.001 |
Disease status at transplant, % |
|
|
|
|
CR |
68 |
73 |
62 |
0.355 |
PR |
24 |
17 |
31 |
|
SD/PD |
8 |
10 |
7 |
|
CMV serostatus, % |
|
|
|
|
Recipient positive |
66 |
67 |
64 |
|
Recipient negative |
34 |
33 |
36 |
0.849 |
Stem cell source, % |
|
|
|
|
BM |
29 |
23 |
36 |
0.345 |
PBSC |
71 |
77 |
64 |
|
Conditioning regimen, % |
|
|
|
|
Nonmyeloablative |
76 |
80 |
72 |
0.495 |
Reduced toxicity |
24 |
20 |
28 |
|
HCT-CI, % |
|
|
|
|
0–2 |
52 |
47 |
59 |
0.358 |
3–5 |
48 |
53 |
41 |
|
Table 2. Outcomes1
CPI, checkpoint inhibitor; NRM, non-relapse mortality; OS, overall survival; PFS, progression-free survival |
||||
|
All patients (N = 59) |
No-CPI (n = 30) |
CPI (n = 29) |
p |
---|---|---|---|---|
2-year OS, % |
74 |
71 |
77 |
0.599 |
2-year PFS, % |
65 |
53 |
78 |
0.066 |
2-year relapse/progression rate, % |
13 |
22 |
4 |
0.098 |
2-year NRM, % |
18 |
15 |
21 |
0.578 |
De Philippis C, Legrand-Izadifar F, Bramanti S, et al. Checkpoint inhibition before haploidentical transplantation with posttransplant cyclophosphamide in Hodgkin lymphoma. Blood Adv. 2020;4(7):1242-1249. DOI: 10.1182/bloodadvances.2019001336
Ikegawa S, Meguri Y, Kondo T, et al. PTCy ameliorates GVHD by restoring regulatory and effector T-cell homeostasis in recipients with PD-1 blockade. Blood Adv. 2019;3(23):4081-4094. DOI: 1182/bloodadvances.2019000134
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