Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantati
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ORIGINAL ARTICLE
Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantation Rebeca Bailén 1,2 & Mi Kwon 1,2 & María Jesús Pascual-Cascón 3 & Christelle Ferrà 4 & Jaime Sanz 5 & Anabel Gallardo-Morillo 3 & Abel García-Sola 3 & Anna Torrent 4 & María José Jiménez-Lorenzo 4 & José Luis Piñana 5 & Juan Montoro 5 & Gillen Oarbeascoa 1,2 & Nieves Dorado 1,2 & Ignacio Gómez-Centurión 1 & Cristina Muñoz 1 & Carolina Martínez-Laperche 1,2 & Javier Anguita 1,2,6 & Ismael Buño 1,2 & José Luis Díez-Martín 1,2,6 & on behalf of Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH) Received: 16 June 2020 / Accepted: 26 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLAhaploidentical 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. Keywords GVHD prophylaxis . Unrelated donor HSCT . Post-transplant cyclophosphamide
Introduction Rebeca Bailén and Mi Kwon contributed equally to this work. * Rebeca Bailén [email protected] 1
Department of Hematology and Hemotherapy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
2
Gregorio Marañón Health Research Institute, Madrid, Spain
3
Department of Hematology and Hemotherapy, Hospital Regional Universitario de Málaga, Málaga, Spain
4
Department of Hematology and Hemotherapy, Institut Català d’Oncologia Badalona, Barcelona, Spain
5
Department of Hematology and Hemotherapy, Hospital Universitario y Politécnico La Fe, Valencia, Spain
6
Universidad Complutense de Madrid, Madrid, Spain
Graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation (HSCT) resulting in variable degrees of morbidity, mortality, and qua
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