Abstract

e14706 Background: Stem cell transplantation (SCT) and immune checkpoint inhibitors (ICIs) are both used to treat hematological malignancies. There may sometimes be an overlap in the patient’s exposure to both treatments. Theoretically, ICIs potentiate the graft-versus-tumor effect following SCT but may increase the risk of inflammatory adverse events (AEs). Conversely, immunosuppression following SCT may decrease the risk of immune-mediated AEs. We aim to explore the effect of immunotherapy on the risk and severity of inflammatory AEs following SCT. Methods: We performed a single-center, retrospective chart review including all patients with a hematological malignancy who were treated with immunotherapy and received SCT. Patients who did not receive immunosuppressive regimens after their transplant (e.g., autologous transplants) were excluded. Patients were divided into 2 groups based on the timing of ICI: pre-SCT ICI (group 1) and post-SCT ICI (group 2). We gathered clinical data including patient demographics, post-SCT immunosuppressive regimens, and pre- and post-SCT inflammatory AEs. Results: 63 patients were included. Around 82% of patients in group 1 experienced a post-transplant AE compared to 50% in group 2 ( p = 0.014). These AEs occurred earlier in group 1 patients (median 57 days in group 1 vs. 195 in group 2; p = 0.007). Roughly 80% of the inflammatory conditions involved the gastrointestinal system. Severity and complication rates did not differ between groups, but gastrointestinal inflammation in group 1 was more likely to require immunosuppressive medication (75.7% and 37.8% requiring corticosteroids and selective immunosuppressive therapy, respectively, in group 1 patients vs. 33.3% and 0% in group 2 patients; p < 0.05). Conclusions: To our knowledge, our study is one of few exploring the impact of ICI timing in relation to SCT on the risk of post-SCT inflammatory AEs. Administration of immunotherapy prior to SCT may predispose patients to inflammatory AEs after SCT, which may occur earlier and last longer than if ICIs are started after SCT. Future studies are needed to further explore this phenomenon. [Table: see text]

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