Dr. Chiara De Philippis, who works at Humanitas Hematology directed by Professor Armando Santoro, in particular in the team of Dr. Luca Castagna, won the Jian Luan Award: the award for the best abstract dedicated to lymphomas at the 45th annual meeting of the European Society for Blood and Marrow Transplantation (EBMT), held in Frankfurt from 24 to 27 March this year. The work of Dr. De Philippis (entitled “Checkpoint inhibitor treatment before haploidentical transplantation in relapsed or refractory Hodgkin Lymphoma patients is associated with higher PFS without increased toxicities”), is dedicated to the impact of treatment with the so-called “checkpoint inhibitors” before allogeneic bone marrow transplantation in patients with Hodgkin’s Lymphoma. As Dr. De Philippis explains: ” This is a retrospective study that involved 54 patients with Hodgkin’s Lymphoma who underwent haploidentical bone marrow transplantation from 2014 to 2018, in Humanitas as well as in two other French centres”.

Pre-treatment with checkpoint inhibitors before marrow transplantation

“For several years now we have available drugs called checkpoint inhibitors (such as nivolumab), a new type of immunotherapy capable of activating the patient’s immune system against the disease, stimulating an immune response against cancer cells. Their use before an allogeneic bone marrow transplant (i.e. from an external donor) could on the one hand contribute to increasing the immune response to the disease, but it could also carry with it a high risk of immunological toxicity. In fact, after allogeneic marrow transplantation, the patient inherits both the hematopoietic system (red and white blood cells, platelets) and the donor’s immune system, with consequent complications related to the risk that the donor’s immune system does not recognize as its own some of the recipient’s tissues and attacks them. It is a specific complication known as GVHD, or Graft-Versus-Host-Disease. That’s why, shortly after the introduction of these drugs, an alert was issued by the FDA (Food and Drugs Administration) on the use of these drugs before an allogeneic transplant,” says the hematologist.

The purpose and the results of the study

“With this study we evaluated the difference in efficacy and toxicity in Hodgkin’s Lymphoma patients undergoing allogeneic transplantation. There were two groups of patients: one group (28 patients) was treated with checkpoint inhibitors before transplantation, while the second group (26 patients) underwent transplantation without previous exposure to these drugs.

It emerged that the two groups did not have different toxicity; in particular, the observed incidence of acute GVHD was the same in the two groups and no cases of severe acute GHVD were observed. Therefore, the treatment with checkpoint inhibitors prior to transplantation does not appear to increase the risk of immunological toxicity. As far as efficacy is concerned, the treatment with checkpoint inhibitors before transplantation is linked to a lower risk of recurrence and therefore increases disease-free survival. However, it should be noted that this is a study that involved a small number of patients and that further studies will therefore be necessary in the future,” concluded Dr. De Philippis.