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Fonseca-Santos M, Bailen R, Lopez-Godino O, Herruzo-Delgado B, Bermudez MA, García-Cadenas I, Huguet-Mas M, Ferra-Coll C, Esquirol A, Cortés-Rodriguez M, Yañez-Sansegundo L, Pascual-Cascon MJ, Heras I, Kwon M, Lopez-Corral L. Characterization of Chronic Graft-versus-host Disease After Haploidentical Stem Cell Transplantation With Posttransplant Cyclophosphamide: A Study on Behalf of GETH-TC. Transplantation 2024; 108:2134-2143. [PMID: 38685204 DOI: 10.1097/tp.0000000000005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Chronic graft-versus-host disease (cGVHD) is a cause of late morbidity and nonrelapse mortality (NRM) after allogenic hematopoietic stem cell transplantation (allo-HSCT). Although studies evaluating haploidentical allo-HSCT (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) demonstrate lower cGVHD rates, comprehensive data describing the clinical profile, risk factors, or outcomes of cGVHD within this platform are scarce. METHODS We conducted a retrospective multicenter analysis of 389 consecutive patients who underwent haplo-HSCT PTCy in 7 transplant centers of the Spanish Group Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) between 2008 and 2020 describing incidence, clinical profile, risk factors, and cGVHD outcomes. RESULTS Ninety-five patients of 389 developed cGVHD. Our data revealed that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis and that the strongest predictor for cGVHD was previous acute GVHD ( P = 0.031). Also, recipient age ≥60 y ( P = 0.044) was protective against cGVHD. Moreover, patients with moderate cGVHD had longer event-free survival at 3 y than other patients ( P = 0.016) and a lower relapse rate at 3 y ( P = 0.036). CONCLUSIONS Our results support the fact that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis. In this series, patients who develop moderate cGVHD after haplo-HSCT PTCy had a higher overall survival and event-free survival, and lower relapse, suggesting higher graft-versus-leukemia effect. Although this is the largest series focused on characterizing cGVHD in haplo-HSCT PTCy, further prospective studies are needed to confirm the findings.
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Affiliation(s)
- Marta Fonseca-Santos
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Rebeca Bailen
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Oriana Lopez-Godino
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | - Maria Aranzazu Bermudez
- Servicio de Hematologia y Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - María Huguet-Mas
- Hematology Department, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - María Cortés-Rodriguez
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
- Statistical Department, Universidad de Salamanca, Salamanca, Spain
| | - Lucrecia Yañez-Sansegundo
- Servicio de Hematologia y Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Inmaculada Heras
- Hematology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Mi Kwon
- Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Lucía Lopez-Corral
- Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
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Esquirol A, Pascual MJ, Montoro J, Piñana JL, Ferrà C, Herruzo B, Garcia-Cadenas I, Balaguer A, Perez A, Huguet M, Redondo S, Villalba M, Hernandez-Boluda JC, Chorao P, Hernani R, Sanz J, Solano C, Sierra J, Martino R. Comparison of Three Graft-versus-Host Disease Prophylaxis Strategies after T Cell-Replete Haploidentical Hematopoietic Transplantation: Tacrolimus versus Calcineurin Inhibitors + Mycophenolate Mofetil versus Sirolimus + Mycophenolate Mofetil. Transplant Cell Ther 2024; 30:1025.e1-1025.e14. [PMID: 39116938 DOI: 10.1016/j.jtct.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
Since the introduction of post-transplantation cyclophosphamide (PTCy), haploidentical hematopoietic stem cell transplantation (haploSCT) has become a real alternative for patients who lack other eligible donors. The standard graft-versus-host disease (GVHD) prophylaxis after PTCy has been a calcineurin inhibitor (CNI) plus mycophenolate mofetil (MMF) (up to day +35), but promising results with sirolimus (with or without MMF) and single-agent tacrolimus have been published recently. This multicenter retrospective study compared the outcomes of 372 adult haploSCT recipients who received conditioning with thiotepa, busulfan, and fludarabine (TBF), PTCy, and additional GVHD prophylaxis with 1 of 3 strategies: cohort A, single-agent tacrolimus (n = 222); cohort B, CNI + MMF (n = 49); or cohort C, sirolimus + MMF (n = 101). No differences among the 3 cohorts were found in terms of grade II-IV acute GVHD (20% in cohort A, 25% in cohort B, and 30% in cohort C) or grade III-IV acute GVHD (9%, 6%, and 15%, respectively) at 100 days; however, cohort A had the lowest incidence of overall chronic GVHD (24%, 47%, and 52%, respectively; P = .001) and moderate-severe chronic GVHD (13%, 35%, and 33%, respectively; P = .001). There were no differences in 3-year overall survival, progression-free survival, nonrelapse mortality, or relapse among the 3 cohorts. Overall, our study suggests that single-agent tacrolimus, CNI + MMF, and sirolimus + MMF GVHD prophylaxis lead to similar outcomes following haploSCT with TBF and PTCy, with a low incidence of grade III-IV acute GVHD, although possible differences in chronic GVHD require further investigation.
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Affiliation(s)
- Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain.
| | | | - Juan Montoro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Christelle Ferrà
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Beatriz Herruzo
- Hematology Department, Hospital Regional Universitario, Malaga, Spain
| | - Irene Garcia-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Aitana Balaguer
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ariadna Perez
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Maria Huguet
- Hematology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Marta Villalba
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Pedro Chorao
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rafael Hernani
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institutes, Universitat Autonoma of Barcelona, Barcelona, Spain
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Sugita J, Morita K, Konuma T, Yanada M. Allogeneic hematopoietic cell transplantation from alternative donors in acute myeloid leukemia. Ann Hematol 2024:10.1007/s00277-024-05944-0. [PMID: 39153145 DOI: 10.1007/s00277-024-05944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) potentially provides a cure for patients with acute myeloid leukemia (AML) who are unlikely to be cured with chemotherapy alone. Previously, human leukocyte antigen (HLA)-matched related donors were used exclusively, which made the procedure available for a limited proportion of patients. The introduction of high-resolution HLA-typing technology, innovations in immunosuppressive therapy, and improved supportive care measures have significantly changed the situation. Now, patients without a matched related donor have an ample opportunity to receive allogeneic HCT with the use of matched or mismatched unrelated donors, umbilical cord blood grafts, or haploidentical related donors. The outcomes of alternative donor transplantations have improved over the past decades, and the growth of unrelated donor registries as well as the donor diversification have enhanced the chance of finding a suitable donor. With multiple alternative donor choices available for most patients, the donor selection is becoming increasingly important. To discuss the optimal donor choice in case of unavailability of an HLA-matched related donor, this article reviews the existing literature of retrospective and prospective comparisons of different alternative donor transplantations in AML and discusses the current state-of-art modalities in allogeneic HCT using alternative donors.
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Affiliation(s)
- Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masamitsu Yanada
- Department of Hematology and Oncology, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya, 464-8547, Japan.
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Salas MQ, Eikema DJ, Koster L, Maertens J, Passweg J, Finke J, Broers AEC, Koc Y, Kröger N, Ozkurt ZN, Pascual-Cascon MJ, Platzbecker U, Van Gorkom G, Schroeder T, López-Lorenzo JL, Martino M, Chiusolo P, Kaufmann M, Onida F, Gurnari C, Scheid C, Drozd-Sokolowska J, Raj K, Robin M, McLornan DP. Impact of post-transplant cyclophosphamide (PTCy)-based prophylaxis in matched sibling donor allogeneic haematopoietic cell transplantation for patients with myelodysplastic syndrome: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2024; 59:479-488. [PMID: 38253869 DOI: 10.1038/s41409-023-02159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024]
Abstract
We retrospectively compared outcomes of 404 MDS patients undergoing 1st matched sibling donor allo-HCT receiving either PTCy-based (n = 66) or other "conventional prophylaxis" (n = 338; mostly calcineurin inhibitor + methotrexate or MMF). Baseline characteristics were balanced, except for higher use of myeloablative regimens in the PTCy group (52.3% vs. 38.2%, p = 0.047). Incidences of neutrophil (Day +28: 89% vs. 97%, p = 0.011) and platelet (Day +100: 89% vs. 97%, p < 0.001) engraftment were lower for PTCy-based. Day +100 cumulative incidences of grade II-IV and III-IV aGVHD, and 5-year CI of extensive cGVHD were 32%, 18% and 18% for PTCy-based and 25% (p = 0.3), 13% (p = 0.4) and 31% (p = 0.09) for the conventional cohort. Five-year OS (51% vs. 52%, p = 0.6) and GRFS (33% vs. 25%, p = 0.6) were similar between groups. Patients receiving PTCy had a trend to a lower cumulative incidence of relapse (20% vs. 33%, p = 0.06), not confirmed on multivariable analysis (p = 0.3). Although higher NRM rates were observed in patients receiving PTCy (32% vs. 21%, p = 0.02) on univariate analysis, this was not confirmed on multivariate analysis (HR 1.46, p = 0.18), and there was no resultant effect on OS (HR 1.20, p = 0.5). Based on these data, PTCy prophylaxis appears to be an attractive option for patients with MDS undergoing MSD allo-HCT.
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Affiliation(s)
| | | | | | | | | | | | | | - Yener Koc
- Medicana International Hospital Istanbul, Istanbul, Turkey
| | | | | | | | | | | | | | | | - Massimo Martino
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli - Centro Unico Trapianti A. Neri, Reggio C, Italy
| | | | | | - Francesco Onida
- Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico IRCCS, Milan, Italy
| | - Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Kavita Raj
- University College London Hospitals NHS Trust, London, UK
| | - Marie Robin
- Hopital Saint-Louis, APHP, Université de Paris Cité, Paris, France
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Borovkova AS, Paina OV, Semenova EV, Bykova TA, Osipova AA, Slesarchuk OA, Kozhokar PV, Tsvetkova LA, Rakhmanova ZZ, Kozlov AV, Chukhlovin AB, Kazantsev IV, Estrina MA, Goloshchapov OV, Bondarenko SN, Moiseev IS, Kulagin AD, Zubarovskaya LS. Post-transplant сyclophosphamide after matched donor hematopoietic stem cell transplantation in children with acute leukemia. Clin Transplant 2024; 38:e15181. [PMID: 37922213 DOI: 10.1111/ctr.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION The data on post-transplant cyclophosphamide (PTCy) in pediatric acute leukemia after matched allo-HSCT are limited to case series. The present study aimed to assess the results of PTCy-based GVHD prophylaxis in a large cohort of children with acute leukemia after matched allo-HSCT. METHODS A retrospective analysis of 190 pediatric patients with acute leukemia who had a first allograft between 2008 and 2020 from a matched sibling donor (MSD) or matched unrelated donor (MUD) was carried out. In the MSD setting, GVHD prophylaxis consisted of PTCy alone (n = 28) for the study group, and calcineurin inhibitor (CNI) ± antimetabolite (n = 30) for the control group. In MUD setting, most patients in the study group received GVHD prophylaxis with PTCy+CNI+mycophenolate mofetil (n = 42, 66.7%) or PTCy+CNI+sirolimus (n = 12, 19%). All patients (n = 69) in the control group received ATG+CNI+antimetabolite. RESULTS After MUD allo-HSCT, the incidences of acute GVHD grade III-IV and moderate/severe chronic GVHD were significantly lower in the PTCy group compared to control (6.6% vs. 35.0% and 12.7% vs. 47.1%, respectively, p < .0001). Five-year GVHD-free, relapse-free survival (GRFS) after MUD allo-HSCT was higher in the PTCy group compared to control (35.1% vs. 7.3%, p < .0001). At the same time, there was no significant difference between both groups after MSD allo-HSCT. CONCLUSIONS In pediatric acute leukemia, PTCy-based GVHD prophylaxis for MUD allo-HSCT is a feasible and effective option that results in a low incidence of GVHD. Compared to the ATG-based approach, PTCy provides better control of GVHD in children. In pediatric allo-HSCT from MSD, PTCy demonstrates comparable effectiveness to conventional GVHD prophylaxis.
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Li Y, Wang N, Zhang X, Cao Y, Zhang L, Liu A, Zhang Y. Post-transplantation cyclophosphamide as GVHD prophylaxis in allogenic hematopoietic stem cell transplantation: Recent advances and modification. Blood Rev 2023; 62:101078. [PMID: 37031067 DOI: 10.1016/j.blre.2023.101078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Allogenic hematopoietic stem cell transplantation (allo-HSCT) is the most important therapeutic option for hematological disorders, although graft-versus-host disease (GVHD) remains the main cause of mortality. Post-transplantation cyclophosphamide (PTCY) induces immune tolerance and is associated with a low incidence of GVHD and non-relapse mortality. Therefore, PTCY has emerged as a safe and effective GVHD prophylaxis in haploidentical transplantation and has been expanded to matched related or unrelated donor and mismatched unrelated donor HSCT. On the basis of current understanding of the mechanisms of PTCY and antithymocyte globulin (ATG) in the prevention of GVHD, growing evidence suggests that the combination of ATG and PTCY could improve allo-HSCT clinical outcomes. Further research will focus on optimizing PTCY regimens by modifying the timing of administration or adding other immunosuppressive agents.
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Affiliation(s)
- Yun Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Xiaoying Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lingfeng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Aiguo Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China.
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Cooper DL, Manago J, Patel V, Schaar D, Tyno A, Lin Y, Strair R. Universal posttransplant cyclophosphamide after allogeneic transplant, a retrospective single institution study. Leuk Res 2022; 122:106934. [PMID: 36084368 DOI: 10.1016/j.leukres.2022.106934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The excellent results of posttransplant cyclophosphamide in decreasing graft-versus-host disease (GVHD) after haploidentical (HI) allogeneic transplant have challenged current donor selection algorithms. PATIENTS AND METHODS We compared outcomes after matched sibling (MSD) versus alternative donor transplant using identical graft-versus-host disease (GVHD) prophylaxis including posttransplant cyclophosphamide (PTCy. Endpoints included engraftment, time outside of the hospital in the first 100 days after transplant, overall survival (OS), non-relapse mortality (NRM) and percentage of patients disease-free and off immunosuppression (DFOI) at one year and at the last follow-up. RESULTS There were significant differences at baseline between matched donor versus HI donor transplants with higher disease-risk index (DRI), more female-to-male donor recipient pairs and a higher percentage of Black patients in the HI group. Engraftment and time out of the hospital favored MSD and matched unrelated donor transplants. Multivariate analysis showed that high DRI and Black race were associated with decreased survival and Black race was associated with a higher NRM. CONCLUSIONS With the use of PTCy, our results support current donor selection algorithms. The finding of decreased survival and increased NRM in Black patients requires confirmation in a larger number of patients as well as the development of mitigation strategies.
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Affiliation(s)
| | | | | | | | - Anne Tyno
- Rutgers Cancer Institute of New Jersey, USA
| | - Yong Lin
- Rutgers Cancer Institute of New Jersey, USA
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Post-Transplant Cyclophosphamide after Matched Sibling and Unrelated Donor Hematopoietic Stem Cell Transplantation in Pediatric Patients with Acute Myeloid Leukemia. Int J Mol Sci 2022; 23:ijms23158748. [PMID: 35955881 PMCID: PMC9368975 DOI: 10.3390/ijms23158748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
Non-relapse mortality due to GVHD and infections represents a major source of morbidity and mortality in pediatric HSCT recipients. Post-transplant cyclophosphamide (PTCy) has emerged as an effective and safe GVHD prophylaxis strategy, with improved GVHD and relapse-free survival in matched (related and unrelated) and mismatched haploidentical HSCT adult recipients. However, there are no published data in pediatric patients with acute myeloid leukemia who received matched-donor HSCT with PTCy. We demonstrate, in this case series, that the use of PTCy in this population is potentially safe, effective in preventing acute GVHD, does not impair engraftment, is associated with reduced non-relapse mortality, and does not hinder immune reconstitution post HSCT.
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Nakamae H. Systematic overview of HLA-matched allogeneic hematopoietic cell transplantation with post-transplantation cyclophosphamide. Int J Hematol 2022; 116:465-481. [PMID: 35930118 DOI: 10.1007/s12185-022-03428-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
The successful application of post-transplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis in HLA-haploidentical allogeneic hematopoietic cell transplantation (allo-HCT) led to the expansion of its application to HLA-matched related and unrelated allo-HCT. Notably, single-agent PTCy was found to be feasible for GVHD prevention in HLA-matched bone marrow transplantation. Single-agent PTCy prophylaxis was later attempted to control GVHD in HLA-matched peripheral blood stem cell transplantation (PBSCT), but this approach was inadequate to alleviate GVHD as evidenced by the high incidence of severe GVHD and/or non-relapse mortality. Therefore, various combinations of immunosuppressants with PTCy have been explored to identify the optimal drug combination that would efficiently prevent GVHD in HLA-matched PBSCT. A recent murine study helped clarify the putative mechanism underlying the activity of PTCy, demonstrating that PTCy impairs the proliferation and function of alloreactive T cells from the donor, but does not eliminate alloreactive T cells altogether. In addition, imbalanced reconstitution of NK cell as well as T cells has been observed in HLA-haploidentical allo-HCT. Therefore, it remains unclear whether or not PTCy-containing GVHD prophylaxis should replace the classical GVHD prophylaxis regimen in the HLA-matched setting, and convincing evidence supporting the benefits of PTCy is needed.
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Affiliation(s)
- Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
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