Recommendations for PD-1 blockade after allo-HCT
| Recommendations . |
|---|
| Patient specific |
| Consideration of the following characteristics: |
| History of GVHD: clinical data suggest higher risk in patients with history of GVHD |
| Timing of relapse after transplant: safety profile seems better for relapse occurring >180 d; murine and clinical data suggest higher risk when given earlier posttransplant |
| Weighing the risks/benefits of checkpoint blockade in light of other therapeutic options* |
| PD-1 blockade strategy |
| Start anti-PD-1 at a low dose (eg, nivolumab 0.5 mg/kg) and consider escalation if no response and no toxicity |
| Perform close monitoring of teGVHD |
| Management of teGVHD |
| Stop anti-PD-1 therapy immediately |
| 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 specific |
| Consideration of the following characteristics: |
| History of GVHD: clinical data suggest higher risk in patients with history of GVHD |
| Timing of relapse after transplant: safety profile seems better for relapse occurring >180 d; murine and clinical data suggest higher risk when given earlier posttransplant |
| Weighing the risks/benefits of checkpoint blockade in light of other therapeutic options* |
| PD-1 blockade strategy |
| Start anti-PD-1 at a low dose (eg, nivolumab 0.5 mg/kg) and consider escalation if no response and no toxicity |
| Perform close monitoring of teGVHD |
| Management of teGVHD |
| Stop anti-PD-1 therapy immediately |
| 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.