Safety and efficacy of allogeneic hematopoietic stem cell transplant after PD-1 blockade in relapsed/refractory lymphoma Journal Article

Authors: Merryman, R. W.; Kim, H. T.; Zinzani, P. L.; Carlo-Stella, C.; Ansell, S. M.; Perales, M. A.; Avigdor, A.; Halwani, A. S.; Houot, R.; Marchand, T.; Dhedin, N.; Lescaut, W.; Thiebaut-Bertrand, A.; François, S.; Stamatoullas-Bastard, A.; Rohrlich, P. S.; Wallet, H. L.; Castagna, L.; Santoro, A.; Bachanova, V.; Bresler, S. C.; Srivastava, A.; Kim, H.; Pesek, E.; Chammas, M.; Reynolds, C.; Ho, V. T.; Antin, J. H.; Ritz, J.; Soiffer, R. J.; Armand, P.
Article Title: Safety and efficacy of allogeneic hematopoietic stem cell transplant after PD-1 blockade in relapsed/refractory lymphoma
Abstract: Anti-programmed cell death protein 1 (PD-1) monoclonal antibodies are being increasingly tested in patients with advanced lymphoma. Following treatment, many of those patients are likely to be candidates for allogeneic hematopoietic stem cell transplant (HSCT). However, the safety and efficacy of HSCT may be affected by prior PD-1 blockade. We conducted an international retrospective analysis of 39 patients with lymphoma who received prior treatment with a PD-1 inhibitor, at a median time of 62 days (7-260) before HSCT. After a median follow-up of 12 months, the 1-year cumulative incidences of grade 2-4 and grade 3-4 acute graft-versus-host disease (GVHD) were 44% and 23%, respectively, whereas the 1-year incidence of chronic GVHD was 41%. There were 4 treatment-related deaths (1 from hepatic sinusoidal obstruction syndrome, 3 from early acute GVHD). In addition, 7 patients developed a noninfectious febrile syndrome shortly after transplant requiring prolonged courses of steroids. One-year overall and progression-free survival rates were 89% (95% confidence interval [CI], 74-96) and 76% (95% CI, 56-87), respectively. One-year cumulative incidences of relapse and nonrelapse mortality were 14% (95% CI, 4-29) and 11% (95% CI, 3-23), respectively. Circulating lymphocyte subsets were analyzed in 17 patients. Compared with controls, patients previously treated with PD-1 blockade had significantly decreased PD-1+ T cells and decreased ratios of T-regulatory cells to conventional CD4 and CD8 T cells. In conclusion, HSCT after PD-1 blockade appears feasible with a low rate of relapse. However, there may be an increased risk of early immune toxicity, which could reflect long-lasting immune alterations triggered by prior PD-1 blockade. © 2017 by The American Society of Hematology.
Journal Title: Blood
Volume: 129
Issue: 10
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2017-03-09
Start Page: 1380
End Page: 1388
Language: English
DOI: 10.1182/blood-2016-09-738385
PROVIDER: scopus
PMCID: PMC5345733
PUBMED: 28073785
Notes: Article -- Export Date: 2 May 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Miguel-Angel Perales
    354 Perales