Timing of Post-Transplantation Cyclophosphamide Administration in Haploidentical Transplantation: A Comparative Study on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Ruggeri, Annalisa; Labopin, Myriam; Battipaglia, Giorgia; Chiusolo, Patrizia; Tischer, Johanna; Diez-Martin, Jean Luiz; Bruno, Benedetto; Castagna, Luca; Moiseev, Ivan Sergeevich; Vitek, Antonin; Rovira, Montserrat; Ciceri, Fabio; Bacigalupo, Andrea; Nagler, Arnon und Mohty, Mohamad (2020): Timing of Post-Transplantation Cyclophosphamide Administration in Haploidentical Transplantation: A Comparative Study on Behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. In: Biology of Blood and Marrow Transplantation, Bd. 26, Nr. 10: S. 1915-1922

Abstract

The timing of immunosuppressive therapy used in combination with post-transplantation cyclophosphamide (PTCY) in haploidentical hematopoietic stem cell transplant (haplo-HSCT) is not standardized. We evaluated the schedules of immunosuppression therapy after haplo-HSCT in 509 patients with acute leukemia receiving PTCY on days +3 and +4 along with tacrolimus (group 1;n = 215), with cyclosporine A (CSA) and mycophenolate mofetil (MMF) from day +5 (group 2;n = 170), or CSA + MMF from day 0 or 1 with PTCY on days +3 and +5 (group 3;n = 124). Compared with the other 2 groups, patients in group 3 were younger (median age, 46 years;P = .02) and more often received bone marrow (77%;P < .01) and a regimen containing thiotepa, fludarabine, and busulfan (84%;P<.01). At 2 years, overall survival was 44% was in group 1, 48% in group 2, and 59% in group 3 (P=.15);leukemia-free survival (LFS) was 43%, 46%, and 53% (P=.05);and refined graft-versus-host disease-free, relapse-free survival (rGRFS) was 33%, 39%, and 36% (P = .02). The incidence of grade II-IV acute GVHD was 25% in group 1, 39% in group 2, and 18% in group 3 (P<.01);incidence of chronic GVHD was 25%, 21%, and 24% (P=.50);relapse incidence was 36%, 37%, and 26% (P=.02);and nonrelapse mortality was 26%, 20%, and 21% (P=.35). On multivariate analysis, early start of immunosuppression therapy at day +1 followed by PTCY was associated with a better LFS (hazard ratio [HR], .58;P=.02) and improved rGRFS (HR, .62;P =.02). In this study, the timing of immunosuppression influenced the outcomes of haplo-HSCT with PTCY. An early start of CSA + MMF with PTCY administered on days +3 and +5 improves LFS and rGRFS. (c) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1083-8791
• Sprache: Englisch