Researchers concluded that post-transplantation cyclophosphamide (PTCy) significantly improved graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) after hematopoietic cell transplantation (HCT) compared to conventional prophylactic regimens. Their findings were published in Transplantation and Cellular Therapy.
Notably, PTCy was advantaged in both human-leukocyte antigen (HLA)-matched sibling (MSD) and matched-unrelated (MUD) donor transplantations, according to the study’s lead author Rohtesh S. Mehta.
The retrospective single-center analysis included 964 patients. Importantly, anti-thymocyte globulin (ATG) was administered to all MUD patients who received tacrolimus/methotrexate, thus necessitating two separate comparisons: tacrolimus/methotrexate/ATG (n=306) versus PTCy-based regimens (n=246) in the MUD cohort, and tacrolimus/methotrexate (n=272) versus PTCy regimens (n=140) in the MSD cohort.
GVHD Prophylaxis Comparison Results
The report noted that both PTCy groups had significantly delayed neutrophil engraftment and higher risks of hemorrhagic cystitis and bacterial infection when compared to the tacrolimus/methotrexate groups. However, the risk of viral infections and related deaths were significantly higher for the tacrolimus/methotrexate/ATG group in the MUD cohort, according to the authors.
Additionally, the authors reported that the risk of grade III-IV acute GVHD was similar between the prophylaxis subgroups in both the MSD and MUD cohort, but the risk of chronic GVHD was significantly lower with PTCy in the MSD cohort. PTCy was also associated with significantly lowered risk of non-relapse mortality and improved progression-free survival in the MUD cohort.
Based on their results, the authors ultimately concluded that PTCy-based GVHD prevention appeared to be advantaged after HCT compared to tacrolimus/methotrexate in MSD and tacrolimus/methotrexate/ATG in MUD recipients.
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