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PD-1 blockade for relapsed lymphoma post-allogeneic hematopoietic cell
transplant: high response rate but frequent GVHD
#MMPMID28468799
Haverkos BM
; Abbott D
; Hamadani M
; Armand P
; Flowers ME
; Merryman R
; Kamdar M
; Kanate AS
; Saad A
; Mehta A
; Ganguly S
; Fenske TS
; Hari P
; Lowsky R
; Andritsos L
; Jagasia M
; Bashey A
; Brown S
; Bachanova V
; Stephens D
; Mineishi S
; Nakamura R
; Chen YB
; Blazar BR
; Gutman J
; Devine SM
Blood
2017[Jul]; 130
(2
): 221-228
PMID28468799
show ga
Given the limited treatment options for relapsed lymphoma post-allogeneic
hematopoietic cell transplantation (post-allo-HCT) and the success of programmed
death 1 (PD-1) blockade in classical Hodgkin lymphoma (cHL) patients, anti-PD-1
monoclonal antibodies (mAbs) are increasingly being used off-label after
allo-HCT. To characterize the safety and efficacy of PD-1 blockade in this
setting, we conducted a multicenter retrospective analysis of 31 lymphoma
patients receiving anti-PD-1 mAbs for relapse post-allo-HCT. Twenty-nine (94%)
patients had cHL and 27 had ?1 salvage therapy post-allo-HCT and prior to
anti-PD-1 treatment. Median follow-up was 428 days (range, 133-833) after the
first dose of anti-PD-1. Overall response rate was 77% (15 complete responses and
8 partial responses) in 30 evaluable patients. At last follow-up, 11 of 31
patients progressed and 21 of 31 (68%) remain alive, with 8 (26%) deaths related
to new-onset graft-versus-host disease (GVHD) after anti-PD-1. Seventeen (55%)
patients developed treatment-emergent GVHD after initiation of anti-PD-1 (6
acute, 4 overlap, and 7 chronic), with onset after a median of 1, 2, and 2 doses,
respectively. GVHD severity was grade III-IV acute or severe chronic in 9
patients. Only 2 of these 17 patients achieved complete response to GVHD
treatment, and 14 of 17 required ?2 systemic therapies. In conclusion, PD-1
blockade in relapsed cHL allo-HCT patients appears to be highly efficacious but
frequently complicated by rapid onset of severe and treatment-refractory GVHD.
PD-1 blockade post-allo-HCT should be studied further but cannot be recommended
for routine use outside of a clinical trial.
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