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Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantation.

Authors :
Bailén R
Kwon M
Pascual-Cascón MJ
Ferrà C
Sanz J
Gallardo-Morillo A
García-Sola A
Torrent A
Jiménez-Lorenzo MJ
Piñana JL
Montoro J
Oarbeascoa G
Dorado N
Gómez-Centurión I
Muñoz C
Martínez-Laperche C
Anguita J
Buño I
Díez-Martín JL
Source :
Annals of hematology [Ann Hematol] 2021 Feb; Vol. 100 (2), pp. 541-553. Date of Electronic Publication: 2020 Nov 02.
Publication Year :
2021

Abstract

Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLA-haploidentical HSCT. The use of PTCY in the unrelated donor HSCT setting is less explored. We conducted a retrospective study of 132 consecutive patients undergoing a matched or 9/10 mismatched unrelated donor HSCT in 4 centers in Spain, 60 with anti-thymocyte globulin (ATG)-based prophylaxis combined with MTX-CsA, and 72 using a PTCY-based regimen. Peripheral blood stem cells were used as graft in most patients (111 patients, 84%); mMUD donors were balanced between groups. Cumulative incidences of grades II-IV and III-IV acute GVHD at 100 days were lower in the PTCy group (46% vs. 67%, p = 0.008; 3% vs. 34%, p = 0.003), without statistically significant differences in the 2-year cumulative incidence of chronic moderate-severe GVHD. At 2 years, no significant differences were observed in overall survival, event-free survival, cumulative incidence of relapse, and non-relapse mortality. GVHD was the most frequent cause of NRM in the ATG group. No differences were observed between groups in the composite endpoint of GVHD-free and relapse-free survival. In this study, PTCy combined with additional immunosuppression after MUD/mMUD HSCT showed a reduction of aGVHD rate with safety results comparable to those obtained with the ATG-based prophylaxis.

Details

Language :
English
ISSN :
1432-0584
Volume :
100
Issue :
2
Database :
MEDLINE
Journal :
Annals of hematology
Publication Type :
Academic Journal
Accession number :
33140137
Full Text :
https://doi.org/10.1007/s00277-020-04317-7