Recommendations for patients receiving PD-1 blockade
| Recommendations . |
|---|
| Patient selection |
| Early referral to transplant center for all patients who may be allo-HCT candidates* |
| Consider allo-HCT for patients in remission (PR or CR) after PD-1 blockade with very limited post–PD-1 salvage options (ie, low chance to reach a new objective response)* |
| Consider allo-HCT for any patient after failure of auto-HCT and PD-1 blockade who achieves subsequent remission |
| Transplant strategy |
| Hold PD-1 therapy for at least 6 wk before allo-HCT |
| Use VOD prophylaxis (ie, ursodiol) and monitor closely for VOD* |
| Reduce the risk of GVHD by favoring: |
| Bone marrow source |
| RIC |
| PtCy-based GVHD prophylactic regimen (eg, PtCy/tacrolimus/MMF)* |
| Perform close monitoring of early transplant complications (eg, noninfectious febrile syndrome) |
| Management of transplant complications |
| In the case of noninfectious febrile syndrome: |
| Consider rapid initiation of IV methylprednisolone at 1 mg/kg per day* |
| In the case of GVHD: |
| Rapid initiation of IV methylprednisolone at 2 mg/kg per day |
| Early intervention with second-line immunosuppression if the patient does not respond rapidly to steroids: consider ATG for second line* or, alternatively, calcineurin inhibitor + ECP* |
| Recommendations . |
|---|
| Patient selection |
| Early referral to transplant center for all patients who may be allo-HCT candidates* |
| Consider allo-HCT for patients in remission (PR or CR) after PD-1 blockade with very limited post–PD-1 salvage options (ie, low chance to reach a new objective response)* |
| Consider allo-HCT for any patient after failure of auto-HCT and PD-1 blockade who achieves subsequent remission |
| Transplant strategy |
| Hold PD-1 therapy for at least 6 wk before allo-HCT |
| Use VOD prophylaxis (ie, ursodiol) and monitor closely for VOD* |
| Reduce the risk of GVHD by favoring: |
| Bone marrow source |
| RIC |
| PtCy-based GVHD prophylactic regimen (eg, PtCy/tacrolimus/MMF)* |
| Perform close monitoring of early transplant complications (eg, noninfectious febrile syndrome) |
| Management of transplant complications |
| In the case of noninfectious febrile syndrome: |
| Consider rapid initiation of IV methylprednisolone at 1 mg/kg per day* |
| In the case of GVHD: |
| Rapid initiation of IV methylprednisolone at 2 mg/kg per day |
| Early intervention with second-line immunosuppression if the patient does not respond rapidly to steroids: consider ATG for second line* or, alternatively, calcineurin inhibitor + ECP* |
Recommendation based on expert opinion and experience. The other recommendations are based on published data.