Table 3.
Immune checkpoint blockade and allogeneic stem cell transplantation for relapsed lymphoid malignancies.
| PD-1 blockade Pre Allo | PD-1 blockade Post Allo | CTLA-4 Blockade Post Allo | ||||
|---|---|---|---|---|---|---|
| Merryman RW et al 2017 (60) | El-Cheikh J et al 2017 (64) | Haverkos et al 2017(62) | Herbaux et al 2017(63) | El Cheikh J et al 2017 (64) | Davids et al 2016(59) | |
| Patients | 31 HL, 2 DLBCL, 2FL, 2 PMBCL, 1 EATL, 1 MCL | 9 HL | 30 HL 1 NHL |
20 HL | 2 HL | n=28, 7 HL(25%), 4 NHL (14%), 1 MM Myeloid = 20 |
| Med. Time from CBT to allo (range) | 62d (7–260) | 44d (23–100) | NA | NA | NA | NA |
| Med. Time allo to CBT (range) | NA | NA | 26.4mo (4.8–108) | 23 mo(2–111) | 10–28 mo | 675d (198–1830) |
| CBT agent n(%) | Nivo 28 (72), Pembro 11 (28) | Nivo 9(100) | 28 Nivo 3 Pembro |
Nivo (100%) | Nivo 2 (100%) | Ipilimumab 28 (100%) |
| ORR n(%) | 89% HL74%, NHL 13%) | 7 (77.8%) | 77% (95%CI: 58–90) | 95% | 2 (100%) | 1/12 (lymphoid cancers) |
| BR to aPD-1 n(%) | CR 14 (36%) PR 10 (26%) SD 7(18%), PD 8 (21%) |
CR 4 (44%), PR 3 (33%) SD 0 (0%) PD 2 (22%) |
CR: 15(48.4%), PR: 8 (25.8%) SD: 3 (9.7%) PD: 4 |
CR: 8(42%) PR: 10 (52%) |
CR: 2 (100%) | PR: 1/7 in HL |
| IrAE pre/post allo-HSCT | 4(11%), colitis 2(6%), pneumonitis 2 (6%), | NR | 17 TE-GVHD (55%) | NR | NR | 6 patients (21%) n=1 death Gr5 n=3 pneumonitis (2 Gr2, 1 Gr4) n=1 ITP Gr 2 n=1 diarrhea, Gr 2 |
| Treatment Emergent Gr. 2–4 aGVHD (%, 95%CI) | 44% | 9(100%) | 10 (32%) | 6 (30%) | 100% | NR, Gut n=1 Gr2 |
| Treatment Emergent Gr. 3–4 aGVHD (%, 95%CI) | 23(11–37) | 6(66%) | 6 (19%) | 5 (25%) | 2(100%) | 0 |
| 1 year cGVHD (%, 95%CI) | 41(22–60) | NR† | NR | NR | NR | 3 cases cGVHD liver (not graded) |
| 1 year TRM (%) | 10%* | 1 (11%; VOD) | 8 (4 aGVHD, 4 cGVHD) | 2 (10%) | NR | 1 (3.6%) |
| Median Follow Up (range) | 12 (2–33) | 10 mo (5–19) | 428 (133–833) | 370 days (24–486) | 1.3–8 | 15mo (8–27) |
| 1 year OS (%, 95%CI) | 89(74–96) | NR | NR (21/31 patients alive at study conclusion; mean 400 days) | 78% at 16 mo | NR | 49% |
| PFS (%, 95% CI) | 76(56–87) at 1 year | NR | Median PFS 591 days (95%CI: 400–644) | median not reached | NR | 17.9% |
aGVHD = acute graft versus host disease, CBT = checkboint blockade therapy cGVHD = chronic graft versus host disease, IrAE = immune related adverse event, ITP = immune thrombocytopenia purpura, Nivo = Nivolumab (anti-PD-1), Pembro = Pembrolizumab (anti-PD-1), Ipi = ipilimumab (antiCTLA-4), NA = not applicable, NR = Not Reported, PFS = progression free survival, TRM = treatment related mortality, VOD = Veno-occlusive disease. *One patient with enteropathy-associated T cell lymphoma received ipilimumab concurrently with anti-PD-1 therapy who died with grade 4 aGVHD, the remained had HL. †two patients had ‘mild chronic’ GVHD, and one patient had ‘severe chronic’ GVHD.