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Graft versus host disease in unmanipulated haploidentical marrow transplantation with a modified post-transplant cyclophosphamide (PT-CY) regimen: an update on 425 patients.

Authors :
Bacigalupo A
Maria Raiola A
Dominietto A
Di Grazia C
Gualandi F
Lint MTV
Chiusolo P
Laurenti L
Sora F
Giammarco S
Angelucci E
Source :
Bone marrow transplantation [Bone Marrow Transplant] 2019 Aug; Vol. 54 (Suppl 2), pp. 708-712.
Publication Year :
2019

Abstract

This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II-IV was 29%, and the CI of GvHD-grade III-IV was 4%. We found older donors and older patients to have higher rates of grade II-IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III-IV acute GvHD, on overall survival. The CI of moderate-severe chronic GvHD was 18%: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.

Details

Language :
English
ISSN :
1476-5365
Volume :
54
Issue :
Suppl 2
Database :
MEDLINE
Journal :
Bone marrow transplantation
Publication Type :
Academic Journal
Accession number :
31431716
Full Text :
https://doi.org/10.1038/s41409-019-0594-1