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Nivolumab in a patient with refractory Hodgkin’s lymphoma after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 51, pages 443–445 (2016)Cite this article

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Allogeneic stem cell transplantation (alloSCT) is still one of the most powerful tools for the treatment of hematological malignancies.1 The immune-mediated graft-versus-tumor (GVT) effect endows it with the potential to cure malignancies refractory to all other treatments. Nevertheless, it is associated with the risk of donor cell-mediated graft-versus-host disease (GVHD), which mainly contributes to its relevant morbidity and lethality. In theory, the GVT effect might be enhanced by immune checkpoint inhibitors such as ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4), nivolumab (anti-programmed cell death 1, PD1) or pembrolizumab (anti-PD1), by releasing the brakes on GVT conveying tumor-suppressed lymphocytes.2 Nevertheless, severe graft-versus-host (GVH) reactions might be unleashed as well. While preliminary data demonstrated no significantly increased GVHD in patients treated with ipilimumab post alloSCT,3 there is still substantial concern regarding the safety of PD1 inhibitors in this setting. In fact, increased GVHD-related lethality has been demonstrated in a murine model of acute GVHD when blocking PD-L1.4 Recently, a report on a patient receiving pembrolizumab for malignant melanoma about 20 years after alloSCT reported no development of GVHD.5 However, there were no data on donor chimerism reported and lack of donor immune cells might be a reasonable cause for lack of GVHD development.

Hodgkin’s lymphoma (HL) is a neoplastic disease of lymphoid origin, that can initially be cured in >75% of patients using chemotherapy, often followed by consolidating radiation.6 Relapsed or refractory (r/r) patients might be salvaged by high-dose therapy and autologous stem cell transplantation. After high-dose therapy, the antibody-drug conjugate brentuximab vedotin (BV) demonstrated very promising results both as consolidation and salvage treatment and is approved in this setting.7, 8 In highly refractory cases alloSCT is considered as a therapeutic option in eligible patients.9

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Authors and Affiliations

  1. Department of Medicine A, Hematology & Oncology, University Hospital Muenster, Muenster, Germany

    L Angenendt, C Schliemann, M Lutz, E Rebber, A B Schulze, C Groth, T Kessler, G Lenz, M Stelljes & W E Berdel

  2. Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany

    M Weckesser, L Stegger & M Schäfers

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  1. L Angenendt
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Correspondence to W E Berdel.

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Angenendt, L., Schliemann, C., Lutz, M. et al. Nivolumab in a patient with refractory Hodgkin’s lymphoma after allogeneic stem cell transplantation. Bone Marrow Transplant 51, 443–445 (2016). https://doi.org/10.1038/bmt.2015.266

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