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Fox ML, García-Cadenas I, Pérez AM, Villacampa G, Piñana JL, Ortí G, Montoro J, Roldán E, Bosch Vilaseca A, Martino R, Salamero O, Saavedra S, Hernandez-Boluda JC, Esquirol A, Sierra J, Sanz J, Solano C, Bosch F, Barba P, Valcarcel D. Feasibility of thiotepa addition to the fludarabine-busulfan conditioning with tacrolimus/sirolimus as graft vs host disease prophylaxis. Leuk Lymphoma 2020; 61:1823-1832. [PMID: 32654570 DOI: 10.1080/10428194.2020.1788015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In classical reduced-intensity conditioning (RIC) regimens, including the fludarabine and busulphan (BF) combination, sirolimus and tacrolimus (SIR-TAC) as graft vs host disease (GVHD) prophylaxis has shown acceptable results. The outcomes of SIR-TAC in a more intense RIC regimen as Thiotepa-fludarabine-busulfan (TBF) have been hardly investigated. This retrospective study included all consecutive patients receiving an allogeneic hematopoietic stem cell transplantation for myeloid malignancies (January 2009-2017) conditioned with either TBF or BF and receiving SIR-TAC. Patients receiving TBF presented higher non-relapse mortality (31.6 vs 12.3%, p = .01), along with shorter overall survival (51.8% vs 77.8%, p < .01) at 2 years than patients treated with BF. There were no significant differences in the cumulative incidence of grade II-IV acute GVHD or moderate-severe chronic GVHD or relapse between both groups. These results suggest that TBF does not seem to improve the traditional RIC BF regimen, at least when associated with SIR-TAC prophylaxis.
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Affiliation(s)
- María Laura Fox
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Irene García-Cadenas
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Ariadna Martínez Pérez
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Guillermo Villacampa
- Oncology Data Science (ODysSey) Group, Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - José Luis Piñana
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Ortí
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Montoro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Elisa Roldán
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anna Bosch Vilaseca
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Olga Salamero
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Silvana Saavedra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | | | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jordi Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant-Pau), Barcelona, Spain.,José Carreras Leukemia Research Institute, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain - CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario- INCLIVA. University of Valencia, Valencia, Spain
| | - Francesc Bosch
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pere Barba
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Valcarcel
- Department of Hematology, Hospital Universitari Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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El-Cheikh J, Devillier R, Dulery R, Massoud R, Al Chami F, Ghaoui N, Moukalled N, Pagliardini T, Marino F, Malard F, Bazarbachi AH, Mohty R, Bazarbachi A, Castagna L, Mohty M, Blaise D. Impact of Adding Antithymocyte Globulin to Posttransplantation Cyclophosphamide in Haploidentical Stem-Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:617-623. [PMID: 32457025 DOI: 10.1016/j.clml.2020.04.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a major cause of mortality after allogeneic stem-cell transplantation. Posttransplantation cyclophosphamide (PT/CY) has become standard prophylaxis of GVHD in T-replete haploidentical transplantation. The question is whether adding antithymocyte globulin (ATG) to PT/CY may further reduce the incidence of GVHD compared to PT/CY only. PATIENTS AND METHODS We retrospectively studied 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine (TBF) conditioning. Sixty-nine patients (26%) received ATG. RESULTS In the ATG group, 3% died due to GVHD versus 8% in the no ATG group. The 100-day and 1-year nonrelapse mortality (NRM) was 0% and 19%, respectively, in the whole cohort. On univariate analysis, the 1-year NRM was 8% versus 23% in patients receiving ATG and no ATG, respectively (P = .005). The no ATG group had a higher incidence of acute GVHD at 12 months compared to the ATG group (22% vs. 12%, respectively, P = .029). The ATG group had better overall survival at 12 months compared to the no ATG group (79% vs. 69%, P = .029). On multivariate analysis, adding ATG to PT/CY had no significant impact on any of the outcomes. A low disease risk index was associated with better overall survival and lower NRM, while Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥ 3 was associated with higher NRM. CONCLUSION ATG can be safely used as part of the pretransplantation conditioning and does not increase the incidence of relapse or complications after transplantation.
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Affiliation(s)
- Jean El-Cheikh
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon.
| | - Raynier Devillier
- Institut Paoli Calmettes, Transplant and Cellular Therapy Unit, Marseille, France
| | - Remy Dulery
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, Paris, France
| | - Radwan Massoud
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Farouk Al Chami
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Nohra Ghaoui
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Nour Moukalled
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Thomas Pagliardini
- Institut Paoli Calmettes, Transplant and Cellular Therapy Unit, Marseille, France
| | - Fabrizio Marino
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Florent Malard
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, Paris, France
| | | | - Razan Mohty
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Ali Bazarbachi
- Division of Hematology and Oncology, American University of Beirut Medical Center, Bone Marrow Transplant Program, Beirut, Lebanon
| | - Luca Castagna
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Mohamad Mohty
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, Paris, France
| | - Didier Blaise
- Institut Paoli Calmettes, Transplant and Cellular Therapy Unit, Marseille, France
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