Molecular and cellular features of CTLA-4 blockade for relapsed myeloid malignancies after transplantation

Blood. 2021 Jun 10;137(23):3212-3217. doi: 10.1182/blood.2021010867.


Relapsed myeloid disease after allogeneic stem cell transplantation (HSCT) remains largely incurable. We previously demonstrated the potent activity of immune checkpoint blockade in this clinical setting with ipilimumab or nivolumab. To define the molecular and cellular pathways by which CTLA-4 blockade with ipilimumab can reinvigorate an effective graft-versus-leukemia (GVL) response, we integrated transcriptomic analysis of leukemic biopsies with immunophenotypic profiling of matched peripheral blood samples collected from patients treated with ipilimumab following HSCT on the Experimental Therapeutics Clinical Trials Network 9204 trial. Response to ipilimumab was associated with transcriptomic evidence of increased local CD8+ T-cell infiltration and activation. Systemically, ipilimumab decreased naïve and increased memory T-cell populations and increased expression of markers of T-cell activation and costimulation such as PD-1, HLA-DR, and ICOS, irrespective of response. However, responding patients were characterized by higher turnover of T-cell receptor sequences in peripheral blood and showed increased expression of proinflammatory chemokines in plasma that was further amplified by ipilimumab. Altogether, these data highlight the compositional T-cell shifts and inflammatory pathways induced by ipilimumab both locally and systemically that associate with successful GVL outcomes. This trial was registered at as #NCT01822509.

Keywords: CHEMOKINES/chemokines; FFPE RNA-seq; IMMUNOBIOLOGY/tumor immunology; MARROW AND STEM CELL TRANSPLANTATION/basic biology; NEOPLASIA/myeloid leukemias and dysplasias: immunotherapeutic approaches; allogeneic stem cell transplantation; graft-versus-leukemia; ipilimumab; myeloid disease.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Allogeneic Cells
  • CD8-Positive T-Lymphocytes / metabolism*
  • CTLA-4 Antigen* / antagonists & inhibitors
  • CTLA-4 Antigen* / genetics
  • CTLA-4 Antigen* / metabolism
  • Female
  • Gene Expression Regulation, Leukemic / drug effects*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Ipilimumab / administration & dosage*
  • Leukemia, Myeloid / genetics
  • Leukemia, Myeloid / metabolism
  • Leukemia, Myeloid / therapy
  • Male
  • Neoplasm Proteins* / antagonists & inhibitors
  • Neoplasm Proteins* / genetics
  • Neoplasm Proteins* / metabolism


  • CTLA-4 Antigen
  • CTLA4 protein, human
  • Ipilimumab
  • Neoplasm Proteins

Associated data