Post-transplantation Cyclophosphamide and Sirolimus after Haploidentical Hematopoietic Stem Cell Transplantation Using a Treosulfan-based Myeloablative Conditioning and Peripheral Blood Stem Cells
| Autor: | Giorgia Levati, Matteo Carrabba, Chiara Bonini, Luca Vago, Fabio Giglio, Fabio Ciceri, Lara Crucitti, Francesca Lorentino, Andrea Assanelli, Laura Bellio, Raffaella Milani, Sarah Marktel, Massimo Bernardi, Maria Teresa Lupo Stanghellini, Consuelo Corti, Raffaella Greco, Tiago De Freitas, Nicoletta Cieri, Jacopo Peccatori, Mara Morelli |
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| Přispěvatelé: | Cieri, N, Greco, R, Crucitti, L, Morelli, M, Giglio, F, Levati, G, Assanelli, A, Carrabba, Mg, Bellio, L, Milani, R, Lorentino, F, Lupo Stanghellini, Mt, De Freitas, T, Marktel, S, Bernardi, M, Corti, C, Vago, L, Bonini, MARIA CHIARA, Ciceri, Fabio, Peccatori, J. |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Transplantation Conditioning Cyclophosphamide Haploidentical transplantation Post transplantation cyclophosphamide medicine.medical_treatment Hematopoietic stem cell transplantation Treosulfan Peripheral Blood Stem Cells Disease-Free Survival Cohort Studies Young Adult Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Transplantation Homologous Post-transplantation cyclophosphamide Busulfan Aged Aged 80 and over Sirolimus Peripheral Blood Stem Cell Transplantation Transplantation Antibiotics Antineoplastic business.industry Myeloablative conditioning Hematopoietic Stem Cell Transplantation Hematology Middle Aged Myeloablative Agonists Allogeneic stem cell transplantation Treatment Outcome surgical procedures operative medicine.anatomical_structure Immunology Female Bone marrow business medicine.drug |
| Popis: | Haploidentical hematopoietic stem cell transplantation (HSCT) performed using bone marrow (BM) grafts and post-transplantation cyclophosphamide (PTCy) has gained much interest for the excellent toxicity profile after both reduced-intensity and myeloablative conditioning. We investigated, in a cohort of 40 high-risk hematological patients, the feasibility of peripheral blood stem cells grafts after a treosulfan-melphalan myeloablative conditioning, followed by a PTCy and sirolimus-based graft-versus-host disease (GVHD) prophylaxis (Sir-PTCy). Donor engraftment occurred in all patients, with full donor chimerism achieved by day 30. Post-HSCT recovery of lymphocyte subsets was broad and fast, with a median time to CD4 > 200/mu L of 41 days. Cumulative incidences of grade II to IV and III-IV acute GVHD were 15% and 7.5%, respectively, and were associated with a significant early increase in circulating regulatory T cells at day 15 after HSCT, with values < 5% being predictive of subsequent GVHD occurrence. The 1-year cumulative incidence of chronic GVHD was 20%. Nonrelapse mortality (NRM) at 100 days and 1 year were 12% and 17%, respectively. With a median follow-up for living patients of 15 months, the estimated 1-year overall and disease-free survival (DFS) was 56% and 48%, respectively. Outcomes were more favorable in patients who underwent transplantation in complete remission (1-year DFS 71%) versus patients who underwent transplantation with active disease (DFS, 34%; P = .01). Overall, myeloablative haploidentical HSCT with peripheral blood stem cells (PBSC) and Sir-PTCy is a feasible treatment option: the low rates of GVHD and NRM as well as the favorable immune reconstitution profile pave the way for a prospective comparative trial comparing BM and PBSC in this specific transplantation setting. (C) 2015 American Society for Blood and Marrow Transplantation. |
| Databáze: | OpenAIRE |
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