Children with multiple relapsed or refractory leukemia have dismal survival. Research has identified engagement of immune checkpoint receptors (e.g., PD-1, PD-L1 and CTLA-4) as a mechanism for treatment resistance. For adult cancer, inhibitors of PD-1 (nivolumab) and CTLA-4 (ipilimumab) have shown promise with response rates ranging from 7 to 40%. In vitro studies using acute myeloid leukemia cell lines have shown that acute myeloid leukemia blasts may similarly utilize the PD-1/PD-L1 axis to evade an anticancer immune response. We report the first case of a pediatric patient with multiple relapsed/refractory leukemia treated with nivolumab, ipilimumab and 5-azacytidine who tolerated therapy with brief improvement of symptoms.
Keyphrases
- acute myeloid leukemia
- allogeneic hematopoietic stem cell transplantation
- immune response
- papillary thyroid
- young adults
- dna damage
- mental health
- childhood cancer
- dendritic cells
- squamous cell carcinoma
- big data
- bone marrow
- mesenchymal stem cells
- machine learning
- toll like receptor
- combination therapy
- depressive symptoms
- oxidative stress
- artificial intelligence
- cell proliferation
- replacement therapy
- lymph node metastasis
- free survival
- case control