GVHD Prophylaxis Using Posttransplant Cyclophosphamide Successful

By Dustin Samples - Last Updated: December 11, 2022

Researchers at the Hospital Clínic de Barcelona in Spain have demonstrated impressive results in a 10-year study of a consecutive cohort of patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT).

Allogeneic HSCT from either matched sibling donors (MSDs) or matched unrelated donors (MUDs) is a standard treatment for patients with high-risk hematological disorders. However, allogeneic HCT carries with it a high risk for graft-versus-host disease (GVHD) as well as transplant-related toxicity and mortality.

María Queralt Salas, MD, and her team added posttransplant cyclophosphamide (PTCy) to their standard GVHD prophylaxis using tacrolimus. She and her colleagues presented the study at the 64th American Society of Hematology Annual Meeting and Exposition

From June 2011 to November 2021, all patients (n=272) receiving peripheral blood allogeneic HCT from either MSDs or MUDs were given either PTCy plus tacrolimus (PTCy-TK) or tacrolimus without PTCy (TK) for GVHD prophylaxis (n=95 vs 177). The TK group received other prophylaxis combining calcineurin inhibitors with methotrexate, mycophenolate mofetil, or sirolimus. The 2 study groups were balanced for age, Karnofsky performance status, HCT-specific comorbidity index, and conditioning regimen intensity.

Patients who received PTCy-TK had significantly better overall survival (OS) at 2 years (70.3% vs 60.8%; P=.021). They also had a trend toward higher relapse-free survival (RFS) at 2 years (62.7% vs 51.8%; P=.065). However, they demonstrated inferior cumulative incidence of relapse (2-year, 18.9% vs. 28.8%; P=.050). “Moreover, the use of PTCy-TK significantly improved GVHD-free/RFS (GRFS) (2-year, 59.5% vs. 16.0%; P<.001),” the report indicates.

The researchers concluded that PTCy-TK for GVHD prophylaxis is more effective for allogeneic HCT from MSDs and MUDs than other prophylaxis not using PTCy.

“Its use at our institution has significantly decreased clinically relevant acute and chronic GVHD, allowing for faster discontinuation of the immunosuppression and contributing to a reduction of disease relapse. Moreover, the use of PTCy-TK has increased posttransplant OS and specially [sic], GRFS.”

Salas MQ, Charry P, Martinez-Cibrian N, et al. Impressive reduction of Gvhd incidence using Ptcy-TK for Gvhd prevention in adults undergoing 10/10 HLA-matched peripheral blood allo-HCT. Abstract #2082. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.

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