Fatal graft-versus-host disease after allogeneic stem cell transplantation in a patient recently exposed to nivolumab

Abstract

Allogeneic hematopoietic stem cell transplantation and checkpoint blockade therapy are immune-based salvage therapies for Hodgkin's lymphoma; however, the use of programmed death 1 blocking agents in the allogeneic stem cell transplantation setting could augment the incidence of steroid refractory graft-versus-host disease. Few studies suggest that that nivolumab is safe in patients previously treated with an allogeneic stem cell transplantation. Likewise, there are very limited data on the use of nivolumab before allogeneic stem cell transplantation. Here, we report a case of fatal graft-versus-host disease in a patient who underwent allogeneic stem cell transplantation 26 days after the last administration of nivolumab. Careful monitoring and close clinical assessment of atypical presentation for graft-versus-host disease in these patients, interval of time from nivolumab administration to allogeneic stem cell transplantation, drug dosage adjustments or more effective allo prophilaxys should been evaluated in prospective clinical trial.

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events: pulmonary toxicity

“…Severe and/or fatal pneumonitis in this setting has been reported rarely, thus underscoring the need for vigilance in carefully selecting and monitoring these patients [36][37][38]. Fatal IrAEs associated with severe graft versus host disease following hematopoietic stem cell transplantation in patients with hematologic malignancies who had been previously exposed to ICI therapies have raised concerns regarding the use of ICIs in this setting [39,40]. These observations are concerning, particularly in the light of emerging evidence that supports the use of PD-1 inhibitors in the treatment of hematologic malignancies [41][42][43].…”

Comprehensive Molecular Profiling for Relapsed/Refractory Pediatric Burkitt Lymphomas—Retrospective Analysis of Three Real-Life Clinical Cases—Addressing Issues on Randomization and Customization at the Bedside

“…There was evidence of partial remission on FDG PET/CT 3 months later and stable disease 6 months later. Due to persistence of a viable tumor on FDG PET/CT and high toxicity of allogenic stem cell transplant reported in nivolumab-treated patients (11), this approach was not considered as treatment of choice. Consequently, personalized immunotherapy with dendritic cell-based vaccine was preferred to support the antitumor immunity, and treatment with dendritic cells loaded with whole tumor lysate according to phase I/II protocol (EudraCT No.…”