Incidence and Risk Factors for Pneumonitis Associated With Checkpoint Inhibitors in Relapsed or Refractory Lymphoma

Area of Science:

• Oncology
• Immunology
• Pulmonology

Background:

• Immune checkpoint inhibitors (ICIs) have transformed lymphoma treatment.
• Immune-related adverse events (irAEs), particularly pneumonitis, are significant concerns.
• Real-world data on ICI-pneumonitis incidence and risk factors in lymphoma are limited.

Purpose of the Study:

• To determine the incidence of pneumonitis in lymphoma patients treated with PD-1 inhibitors.
• To identify demographic, clinical, and treatment-related risk factors for ICI-pneumonitis.
• To analyze the association between ICI-pneumonitis and patient outcomes.

Main Methods:

• Retrospective review of 302 lymphoma patients treated with PD-1 inhibitors.
• Multidisciplinary team adjudication of grade ≥2 pneumonitis using CTCAEv5 criteria.
• Cox proportional hazards models for univariate and multivariate risk factor analysis.

Main Results:

• Pneumonitis occurred in 16/302 patients (5%).
• Independent risk factors for pneumonitis included pre-ICI dyspnea, CTLA-4 combination therapy, IAP antagonists, and PI3K inhibitors.
• Pneumonitis was not associated with increased mortality.

Conclusions:

• The incidence of ICI-pneumonitis in this lymphoma cohort was 5%, generally low-grade.
• Specific co-therapies like CTLA-4 combinations, IAP antagonists, and PI3K inhibitors significantly increase pneumonitis risk.
• Understanding these risk factors can inform clinical management and patient monitoring for ICI-induced pneumonitis.