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EBMT 2017 | Does the use of the checkpoint inhibitor nivolumab affect the outcomes of transplant?

Carmelo Carlo-Stella, MD, PhD, from the Humanitas Clinical and Research Center, Milan, Italy, discusses allogeneic hematopoietic stem cell transplantation outcomes after nivolumab monotherapy for relapsed/refractory Hodgkin lymphoma at the 2017 annual meeting of the European Society for Blood and Marrow Transplantation (EBMT) in Marseille, France. He explains that the availability of checkpoint blockade inhibitors, such as nivolumab or pembrolizumab, has provided unprecedented efficacy results in relapsed and refractory Hodgkin lymphoma. According to Prof. Carlo-Stella, the question now emerging is whether checkpoint inhibitors may eventually affect the outcome of allogeneic stem cell transplantation, which is part of the therapeutic strategy in relapsed and refractory Hodgkin lymphoma patients. He explains that initial results suggest a previous therapy with nivolumab may increase the toxicity of allogeneic stem cell transplantation. An analysis was carried out on all patients receiving an allogeneic stem cell transplantation after nivolumab therapy, and included a total of 49 patients enrolled in two nivolumab trials. Prof. Carlo-Stella describes the results, which show that transplant-related mortality, as well as acute graft versus host disease (GvHD), are comparable between patients who were previously treated with nivolumab and patients without checkpoint inhibitor treatment who underwent allogeneic grafting. He concludes that allografting patients after nivolumab therapy is a possible strategy, and may remain part of the overall therapeutic strategy in the setting of relapsed and refractory Hodgkin lymphoma. However, he highlights that patients who previously received nivolumab should be more closely monitored for the onset of acute GVHD and other unexpected toxicities.

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