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- Title
AML-183: Cyclophosphamide-Based GVHD Prophylaxis After 9/10 and 10/10 HLA Tissue-Matched Unrelated Allogeneic Stem Cell Transplantation: A Multi-Center Experience.
- Authors
Yıldırım, Murat; Sayın, Selim; Cömert, Melda; Yılmaz, Esra Şafak; Avcu, Ferit; Ural, Ali Uğur; Aylı, Meltem
- Abstract
The ideal prophylaxis regimen for graft versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) from an unrelated donor has not yet determined clearly. Comparative studies on anti-thymocyte globulin (ATG), calcineurin inhibitors, methotrexate, mycophenolatmofetil (MMF), post-transplant cyclophosphamide (PTCy), and their combinations are very limited. Although ATG and its combinations have been used frequently in the past, PTCy use has been increasing due to positive developments in recent years. Evaluating the effect of cyclophosphamide-based GVHD prophylaxis after 9/10 and 10/10 HLA tissue-matched unrelated stem cell transplantation was aimed. Patients who underwent allo-HSCT from a 9/10-10/10 HLA tissue-matched unrelated donor and used cyclophosphamide+tacrolimus+methotrexate or cyclophosphamide+cyclosporine for post-transplant GVHD prophylaxis in 3 centers between 2015 and 2020 were reviewed retrospectively. Forty-one patients (25 male and 16 female) were included in the study. The mean age of the patients was 40.8 years (21–67), with 23 AML, 11 ALL, 3 NHL, 2 MDS, 1 biphenotypic leukemia, and 1 HL diagnosis. HLA tissue compatibility was 9/10 in 32 patients and 10/10 in 9 patients. As a myeloablative regimen, 35 patients had TBI (800–1200 cGy)+Flu (30 mg/m2x5), 5 had Cy (60 mg/kgx2)+TBI (1200 cGy),1 had treosulfan (10 gr/m2x3)+Flu (40 mg)/m2x4). In 27 patients, tacrolimus (from the 3rd day)+MTX (+1,+3,+6th day) with PTCy (at hours 72 and 96 after transplantation), in 13 patients cyclosporine (from day +3) with PTCy (at at hours 72 and 96), in 1 patient cyclosporine (from +5th day)+mycophenolate mofetil (from +5th day) together with PTCy (at hours 72 and 96) was given. Mean neutrophil engraftment was on the 18th day (11–31), and mean thrombocyte engraftment was on the 22nd day (9–48). Acute GVHD was observed (Grade I–II) in 26.8% of patients, Grade III–IV in 4.9%, and chronic GVHD in 12.2%. Post-transplant mortality rates were day 30: 4.9%, day 100: 2.2%, day 180: 25.7%, and the first year: 34.3%. Transplant-related mortality was 2.4%, relapse-related mortality was 21.9%, and non-relapse-related mortality was 31.7%. Comparison of our cases with the literature of unrelated allo-HSCT cases treated with ATG were as follows: acute GVHD Grade I–II (26.8% vs 45%), Grade III–IV (4.9 vs 27%), chronic GVHD (12.2% vs 65%), respectively. Recurrence-related and non-relapse-related mortality rates were significantly lower from most literature, and 1-year survival rates are higher than cases with ATG. GVHD prophylaxis containing PTCy after allo-HSCT from an unrelated donor is thought to be more effective and safe than ATG.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2021, Vol 21, pS288
- ISSN
2152-2650
- Publication type
Article
- DOI
10.1016/S2152-2650(21)01690-6