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
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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