Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, Illinois.
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California.
Biol Blood Marrow Transplant. 2020 May;26(5):1025-1027. doi: 10.1016/j.bbmt.2020.01.021. Epub 2020 Feb 1.
Treatment options are limited for patients with hematologic malignancies who relapse after allogeneic stem cell transplantation (allo-SCT). We conducted a pilot study to assess the tolerability and efficacy of low-dose nivolumab, a PD-1 inhibitor, as maintenance therapy after allo-SCT. Of the 4 patients enrolled in the study, all rapidly developed immune-related adverse events (irAEs); 2 patients experienced serious adverse events, including grade 4 neutropenia and grade 3 autoimmune encephalopathy. As a result of these unexpected severe toxicities, the study was closed to further enrollment. Even at low doses, nivolumab maintenance in the post allo-SCT setting can cause serious irAEs beyond graft-versus-host disease, and further studies of dosage and timing after allo-SCT are needed.
对于异基因干细胞移植（allo-SCT）后复发的血液系统恶性肿瘤患者，治疗选择有限。我们进行了一项初步研究，以评估 PD-1 抑制剂低剂量纳武利尤单抗作为 allo-SCT 后维持治疗的耐受性和疗效。在入组的 4 名患者中，所有患者均迅速出现免疫相关不良事件（irAE）；2 名患者发生严重不良事件，包括 4 级中性粒细胞减少和 3 级自身免疫性脑病。由于这些意外的严重毒性，该研究停止进一步入组。即使在低剂量下，纳武利尤单抗在 allo-SCT 后维持治疗也可引起移植物抗宿主病以外的严重 irAE，因此需要进一步研究 allo-SCT 后的剂量和时机。
