Characterizing Chronic GVHD After PTCy Transplants

By Patrick Daly - Last Updated: October 14, 2022

Researchers, led by Marta Fonseca Santos, MD, investigated the incidence, risk factors, and disability related to chronic graft-versus-host disease (cGVHD) after haploidentical stem-cell transplantation (haplo-HSCT) with posttransplant cyclophosphamide (PTCy). In the study, published in Clinical Lymphoma, Myeloma & Leukemia, the authors reported that PTCy regimens led to a “low, but not negligible, incidence of cGVHD.”

This retrospective analysis included 389 patients who received haplo-HSCT with PTCy at 7 transplant centers between 2007 and 2020. The cohort was 62% male and had a median age of 48 years (range, 5-74 years). Subjects were diagnosed with cGVHD according to the National Institutes of Health criteria.

PTCy Prophylaxis is Effective for Haplo-HSCT Patients

Over a median follow-up of 35 months (range, 3-102 months), the cumulative incidence of acute GVHD (aGVHD) and grade III-IV aGVHD at day 180 posttransplant was 66% and 20%, respectively. At year 2, overall survival was 59%, progression-free survival was 54%, and GVHD-free relapse-free survival was 45%. Additionally, 95 patients developed cGVHD, the 3-year cumulative incidence of any cGVHD and moderate-to-severe cGVHD was 34% and 10%, respectively, and 42 patients required systemic treatments.

Univariate risk factors for cGVHD in day-100 survivors included female donor (P=.034), female donor and male recipient (P=.041), low disease risk index (P=.026), myeloablative conditioning (P=.047), prior aGVHD (P=.014), and conditioning with radiotherapy (P=.004). Conversely, conditioning with busulfan was a protective factor against cGVHD (P=.036).

After multivariate analysis, previous GVHD and busulfan conditioning maintained their statistical significance. Ultimately, the authors suggested that haplo-HSCT with PTCy was an effective treatment option for some patients with a manageable proportion of cGVHD.

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