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

Autor:	Alexandr L. Alyanski, Elena V. Babenko, Elena I. Darskaya, Alexei B. Chukhlovin, Sergey N. Bondarenko, Olga A. Slesarchuk, Boris V. Afanasyev, OV Pirogova, TL Gindina, Dmitrii E. Pevtcov, TA Bykova, Ivan S. Moiseev
Rok vydání:	2018
Předmět:	Adult Male medicine.medical_specialty Transplantation Conditioning Cyclophosphamide Adolescent Premedication Graft vs Host Disease Kaplan-Meier Estimate Gastroenterology Nephrotoxicity 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine medicine Clinical endpoint Humans Transplantation Homologous Postoperative Care business.industry Incidence (epidemiology) Graft Survival Hematopoietic Stem Cell Transplantation Hematology General Medicine Middle Aged Tacrolimus Tissue Donors Clinical trial surgical procedures operative medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Toxicity Transplantation Haploidentical Female Bone marrow business Immunosuppressive Agents 030215 immunology medicine.drug
Zdroj:	European journal of haematology. 100(5)
ISSN:	1600-0609
Popis:	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).
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4d07c159cd3704b9651cc90cc9e6cebb https://pubmed.ncbi.nlm.nih.gov/29360184 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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