Department of Hematology, Humanitas Clinical and Research Center-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Italy.
Department of Hematology, Institut Paoli Calmettes, Marseille, France.
Blood Adv. 2020 Apr 14;4(7):1242-1249. doi: 10.1182/bloodadvances.2019001336.
We report on 59 Hodgkin lymphoma patients undergoing haploidentical stem cell transplantation (SCT; haplo-SCT) with posttransplant cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis, comparing outcomes based on pretransplant exposure to checkpoint inhibitors (CPIs). Considering pretransplant characteristics, the 2 cohorts (CPI = 29 patients vs no-CPI = 30 patients) were similar, except for the number of prior lines of therapy (6 vs 4; P < .001). With a median follow-up of 26 months (range, 7.5-55 months), by univariate analysis, the 100-day cumulative incidence of grade 2-4 acute GVHD was 41% in the CPI group vs 33% in the no-CPI group (P = .456), whereas the 1-year cumulative incidence of moderate to severe chronic GVHD was 7% vs 8%, respectively (P = .673). In the CPI cohort, the 2-year cumulative incidence of relapse appeared lower compared with the no-CPI cohort (0 vs 20%; P = .054). No differences were observed in terms of overall survival (OS), progression-free survival (PFS), and nonrelapse mortality (NRM) (at 2 years, 77% vs 71% [P = .599], 78% vs 53% [P = .066], and 15% vs 21% [P = .578], respectively). By multivariable analysis, CPI before SCT was an independent protective factor for PFS (hazard ratio [HR], 0.32; P = .037). Stable disease (SD)/progressive disease (PD) was an independent negative prognostic factor for both OS and PFS (HR, 14.3; P < .001 and HR, 14.1; P < .001, respectively) . In conclusion, CPI as a bridge to haplo-SCT seems to improve PFS, with no impact on toxicity profile.
我们报告了 59 例接受单倍体造血干细胞移植（haplo-SCT）并接受移植后环磷酰胺（PTCy）作为移植物抗宿主病（GVHD）预防的霍奇金淋巴瘤患者，根据移植前是否接触过检查点抑制剂（CPIs）比较了结果。考虑到移植前的特征，两组（CPI=29 例，无-CPI=30 例）相似，除了先前治疗线数（6 对 4；P<.001）。中位随访时间为 26 个月（范围，7.5-55 个月），单因素分析显示，CPI 组 100 天急性 2-4 级 GVHD 的累积发生率为 41%，无-CPI 组为 33%（P=.456），而 1 年时中重度慢性 GVHD 的累积发生率分别为 7%和 8%（P=.673）。在 CPI 组中，与无-CPI 组相比，2 年复发累积发生率较低（0 对 20%；P=.054）。在总生存率（OS）、无进展生存率（PFS）和非复发死亡率（NRM）方面没有差异（2 年时，77%对 71%[P=.599]，78%对 53%[P=.066]，15%对 21%[P=.578]）。多变量分析显示，SCT 前 CPI 是 PFS 的独立保护因素（风险比[HR]，0.32；P=.037）。疾病稳定（SD）/进展（PD）是 OS 和 PFS 的独立不良预后因素（HR，14.3；P<.001 和 HR，14.1；P<.001）。总之，CPI 作为单倍体 SCT 的桥梁似乎可以改善 PFS，而不会影响毒性特征。
