Reduced-toxicity conditioning regimen with low dose post-transplantation cyclophosphamide and low-dose anti-thymocyte globulin as graft-versus-host disease prophylaxis for haploidentical stem cell transplantation in older patients.

Autor: Ye P; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Wu M; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Cao J; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Pei R; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Yuan J; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Zhuang H; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Fang Y; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China., Lu Y; Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China. rmluying@nbu.edu.cn.; Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China. rmluying@nbu.edu.cn.
Jazyk: angličtina
Zdroj: Annals of hematology [Ann Hematol] 2024 Aug; Vol. 103 (8), pp. 3135-3143. Date of Electronic Publication: 2024 May 29.
DOI: 10.1007/s00277-024-05818-5
Abstrakt: Reduced-toxicity conditioning (RIC) regimens are used for allogeneic hematopoietic stem cell transplantation in older patients. However, successful outcomes are hindered by graft-versus-host disease (GVHD), treatment-related mortality, and relapse, particularly after haploidentical donor hematopoietic stem cell transplantation (HID-HSCT). The aim of this study was to evaluate the effectiveness of an RIC conditioning regimen that included a combination of cyclosporin A, methotrexate (on day + 1), mycophenolate, lower doses of post-transplantation PTCy (40 mg/kg on day + 3), and ATG (7.5 mg/kg) as GVHD prophylaxis prior to haplo-stem cell transplantation (haplo-SCT) in older patients.
Methods: We retrospectively analyzed outcomes in 55 patients ≥ 55 years of age with hematologic malignancies treated with fludarabine, cytarabine, busulfan, and low-dose cyclophosphamide as the conditioning regimen between January 1, 2019, and November 30, 2023.
Results: Neutrophil engraftment was successful in all patients within 28 days, with 54 patients (98.2%) achieving complete donor chimerism. The cumulative incidence of non-relapse mortality was 0% at 30 days, 7.5% at 100 days, and 19% at 1 year. The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was 25% (95%CI, 15-38%), whereas that of grade III-IV aGVHD was 9.1% (95% CI, 3.3-19%). The cumulative incidence of extensive chronic graft-versus-host disease at 1 year was 3.6% (95%CI, 0.66-11%). The cumulative incidences of relapse, overall survival, and GVHD-free/relapse-free survival at 1 year were 9.0%, 71.6%, and 67.1%, respectively.
Conclusions: An RIC conditioning regimen, including a combination of lower PTCy/ATG as GVHD prophylaxis, followed by haplo-SCT, might be a promising option for appropriately selected older patients.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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