Post-transplant cyclophosphamide for graft-versus-host disease prophylaxis in HLA matched sibling or matched unrelated donor transplant for patients with acute leukemia, on behalf of ALWP-EBMT
Autor: | Myriam Labopin, Didier Blaise, Noel Milpied, Andrea Bacigalupo, Jan J. Cornelissen, Harry C. Schouten, Arnon Nagler, Boris V. Afanasyev, Mohamad Mohty, Maija Itälä-Remes, Annalisa Ruggeri, Ahmet H. Elmaagacli, Yener Koc, Nicolaus Kroeger, Ellen Meijer |
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Přispěvatelé: | Hematology, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Interne Geneeskunde, MUMC+: MA Hematologie (9), Service d'hématologie clinique et de thérapie cellulaire [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Academic Medical Center |
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Cancer Research
Transplantation Conditioning medicine.medical_treatment GVHD PROPHYLAXIS Graft vs Host Disease Hematopoietic stem cell transplantation SINGLE-AGENT HEMATOLOGIC MALIGNANCIES 0302 clinical medicine HIGH-DOSE CYCLOPHOSPHAMIDE Post-transplantation cyclophosphamide MYCOPHENOLATE-MOFETIL Acute leukemia Hematology lcsh:Diseases of the blood and blood-forming organs Middle Aged lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens 3. Good health METHOTREXATE Leukemia Myeloid Acute medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis PHASE-II SURVIVAL Female Unrelated Donors Immunosuppressive Agents medicine.drug Adult medicine.medical_specialty Adolescent Cyclophosphamide Stem cell source lcsh:RC254-282 HEMATOPOIETIC-CELL TRANSPLANTATION Young Adult 03 medical and health sciences Internal medicine medicine Humans Molecular Biology Aged Retrospective Studies Acute graft-versus-host disease business.industry lcsh:RC633-647.5 Research Siblings medicine.disease BONE-MARROW-TRANSPLANTATION Transplantation Graft-versus-host disease Methotrexate Bone marrow business [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology 030215 immunology |
Zdroj: | Journal of Hematology & Oncology, 11:40. BioMed Central Ltd. Journal of Hematology & Oncology, Vol 11, Iss 1, Pp 1-10 (2018) Journal of Hematology & Oncology, 11:40. BioMed Central Journal of Hematology & Oncology Journal of Hematology and Oncology Journal of Hematology and Oncology, BioMed Central, 2018, 11, pp.40. ⟨10.1186/s13045-018-0586-4⟩ JOURNAL OF HEMATOLOGY & ONCOLOGY, 11(1):40. BioMed Central |
ISSN: | 1756-8722 |
Popis: | International audience; Background: Experience using post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis in allogeneic stem cell transplantation (HSCT) from matched sibling donors (MSD) or unrelated donors (UD) is limited and with controversial results. The study aim was to evaluate PT-Cy as GVHD prophylaxis post-HSCT from MSD and UD transplants. We analyzed 423 patients with acute leukemia who received PT-Cy alone or in combination with other immunosuppressive (IS) drugs as GVHD prophylaxis. Seventy-eight patients received PT-Cy alone (group 1); 204 received PT-Cy in combination with one IS drug—cyclosporine-A (CSA) or methotrexate (MTX) or mycophenolate-mofetil (MMF) (group 2), while 141 patients received PT-Cy in combination with two IS drugs—CSA + MTX or CSA + MMF (group 3). Transplants were performed from 2007 to 2015 and median follow-up was 20 months. Results: Probability of overall survival (OS) at 2 years was 50, 52.2, and 62.4%, for the three groups, respectively, p = 0.06. In multivariate analysis, in comparison to PT-Cy alone, the addition of two IS drugs was associated with reduced risk of extensive cGVHD (HR 0.25, p = 0.02). Use of bone marrow (BM) and anti-thymocyte globulin were independently associated with reduced risk of extensive cGVHD. Prognostic factors for non-relapse mortality (NRM) were the addition of two IS drugs to PT-Cy (HR 0.35, p = 0.04), diagnosis of AML, disease status at transplant, and patient CMV serology. Factors associated with increased OS were the use of PT-Cy with two IS drugs (HR 0.49, p = 0.02), AML, and disease status at transplant. Conclusion: For GVHD prophylaxis in MSD and UD HSCT, the addition of IS drugs to PT-Cy enhances its effect and reduces the risk of severe cGVHD, reducing mortality and improving survival. |
Databáze: | OpenAIRE |
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