Risk-adapted GVHD prophylaxis with post-transplantation cyclophosphamide in adults after related, unrelated, and haploidentical transplantations.

Autor: Moiseev IS; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Pirogova OV; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Alyanski AL; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Babenko EV; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Gindina TL; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Darskaya EI; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Slesarchuk OA; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Bykova TA; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Chukhlovin AB; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Pevtcov DE; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Bondarenko SN; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation., Afanasyev BV; R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation.
Jazyk: angličtina
Zdroj: European journal of haematology [Eur J Haematol] 2018 May; Vol. 100 (5), pp. 395-402. Date of Electronic Publication: 2018 Mar 01.
DOI: 10.1111/ejh.13030
Abstrakt: Introduction: Although a number of studies were published on the efficacy of post-transplantation cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis, no large studies prospectively evaluated this strategy in related, unrelated, and haploidentical grafts.
Methods: In this study, GVHD prophylaxis for 57 matched bone marrow (MBM) grafts consisted of single-agent PTCy, for 88 matched PBSC grafts (MPBSC) consisted of PTCy, tacrolimus, and mycophenolate mofetil (MMF) 30 mg/kg, and for 55 mismatched grafts (MMGs) consisted of PTCy, tacrolimus and MMF 45 mg/kg.
Results: The study met the primary endpoint to demonstrate equivalent rates of acute GVHD grade II-IV (11%, 17%,19%, P = .46), III-IV (7%, 2%, 6%, P = .41), and moderate and severe chronic GVHD (22%, 11%, 15%, P = .23). There was also no differences in non-relapse mortality (11% vs 15% vs 17%, P = .75), overall survival (63% vs 71% vs 56%, P = .72), event-free-survival (51% vs 66% vs 48%, P = .32) for MBM, MPBSC, and MMG groups, respectively. Toxicity was comparable between groups except higher incidence of nephrotoxicity in combination arms (P = .0005) and higher incidence of graft failures in MMG group (P = .004).
Conclusion: The suggested risk-adapted PTCy-based prophylaxis is feasible and is associated with low GVHD incidence and mortality in all types of grafts. The study was registered on clinicaltrials.gov (NCT02294552).
(© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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