Pharmacodynamic Monitoring Predicts Outcomes of CCR5 Blockade as Graft-versus-Host Disease Prophylaxis

• Published in: Biology of blood and marrow transplantation 2018-03, Vol.24 (3), p.594-599
• Main Authors: Huffman, Austin P., Richman, Lee P., Crisalli, Lisa, Ganetsky, Alex, Porter, David L., Vonderheide, Robert H., Reshef, Ran
• Format: Article
• Language: English
• Subjects: Chemokine receptor blockade; GVHD; Maraviroc
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2017.10.028

•A pharmacodynamic assay that quantifies chemokine receptor blockade is described.•Chemokine receptor blockade insufficiency was predictive of worse clinical outcomes.•Baseline recipient T cell CCR5 expression levels were also predictive of clinical outcomes. Blocking lymphocyte trafficking after allogeneic hematopoietic stem cell transplantation is a promising strategy to prevent graft-versus-host disease (GVHD) while preserving the graft-versus-tumor response. Maraviroc, a CCR5 antagonist, has shown promise in clinical trials, presumably by disrupting the migration of effector cells to GVHD target organs. We describe a phosphoflow assay to quantify CCR5 blockade during treatment with maraviroc and used it to evaluate 28 patients in a phase II study. We found that insufficient blockade of CCR5 was associated with significantly worse overall survival (HR, 10.6; 95% CI, 2.2 to 52.0; P = .004) and higher rates of nonrelapse mortality (HR, 146; 95% CI, 1.0 to 20,600; P = .04) and severe acute GVHD (HR, 12; 95% CI, 1.9 to 76.6; P = .009). In addition, we found that pretransplant high surface expression of CCR5 on recipient T cells predicted higher nonrelapse mortality and worse GVHD- and relapse-free survival. Our results demonstrate that pharmacodynamic monitoring of CCR5 blockade unravels interpatient variability in the response to therapy and may serve as a clinically informative biomarker.