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Blood, 12 February 2009, Vol. 113, No. 7, pp. 1581-1588.
Prepublished online as a Blood First Edition Paper on October 30, 2008; DOI 10.1182/blood-2008-07-168468.


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TRANSPLANTATION

CTLA4 blockade with ipilimumab to treat relapse of malignancy after allogeneic hematopoietic cell transplantation

Asad Bashey1,2, Bridget Medina1, Sue Corringham1, Mildred Pasek2, Ewa Carrier1, Linda Vrooman2, Israel Lowy3, Scott R. Solomon2, Lawrence E. Morris2, H. Kent Holland2, James R. Mason4, Edwin P. Alyea5, Robert J. Soiffer5, and Edward D. Ball1

1 Division of Blood and Marrow Transplantation, University of California, San Diego Moores Cancer Center, La Jolla; 2 Blood and Marrow Transplant Group of Georgia at Northside Hospital, Atlanta; 3 Medarex, Bloomsbury, NJ; 4 BMT, Scripps Clinic, La Jolla, CA; and 5 Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA

Relapse of malignancy after allogeneic hematopoietic cell transplantation (allo-HCT) remains a therapeutic challenge. Blockade of the CTLA4 molecule can effectively augment antitumor immunity mediated by autologous effector T cells. We have assessed the safety and preliminary efficacy of a neutralizing, human anti-CTLA4 monoclonal antibody, ipilimumab, in stimulating the graft-versus-malignancy (GVM) effect after allo-HCT. Twenty-nine patients with malignancies that were recurrent or progressive after allo-HCT, received ipilimumab as a single infusion at dose cohorts between 0.1 and 3.0 mg/kg. Dose-limiting toxicity was not encountered, and ipilimumab did not induce graft-versus-host disease (GVHD) or graft rejection. Organ-specific immune adverse events (IAE) were seen in 4 patients (grade 3 arthritis, grade 2 hyperthyroidism, recurrent grade 4 pneumonitis). Three patients with lymphoid malignancy developed objective disease responses following ipilimumab: complete remission (CR) in 2 patients with Hodgkin disease and partial remission (PR) in a patient with refractory mantle cell lymphoma. At the 3.0 mg/kg dose, active serum concentrations of ipilimumab were maintained for more than 30 days after a single infusion. Ipilimumab, as administered in this clinical trial, does not induce or exacerbate clinical GVHD, but may cause organ-specific IAE and regression of malignancy. This study is registered at http://clinicaltrials.gov under NCI protocol ID P6082.


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