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Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation.
Br J Haematol. 2016 05; 173(3):444-55.BJ

Abstract

Post-transplantation cyclophosphamide (PTCy) is an effective strategy to prevent graft-versus-host disease (GVHD) after haploidentical haematopoietic cell transplantation (HCT). We determined the efficacy of PTCy-based GVHD prophylaxis in human leucocyte antigen (HLA)-mismatched unrelated donor (MMUD) HCT. We analysed 113 adult patients with high-risk haematological malignancies who underwent one-antigen MMUD transplantation between 2009 and 2013. Of these, 41 patients received PTCy, tacrolimus and mycophenolate mofetil (MMF) for GVHD prophylaxis; 72 patients received conventional prophylaxis with anti-thymocyte globulin, tacrolimus and methotrexate. Graft source was primarily bone marrow (83% PTCy vs. 63% conventional group). Incidence of grade II-IV (37% vs. 36%, P = 0·8) and grade III-IV (17% vs. 12%, P = 0·5) acute GVHD was similar at day 100. However, the incidence of grade II-IV acute GVHD by day 30 was significantly lower in the PTCy group (0% vs. 15%, P = 0·01). Median time to neutrophil (18 days vs. 12 days, P < 0·001) and platelet (25·5 days vs. 18 days, P = 0·05) engraftment was prolonged in PTCy group. Rates of graft failure, chronic GVHD, 2-year non-relapse mortality, relapse, progression-free survival or overall survival were similar. Our results demonstrate that PTCy, tacrolimus and MMF for GVHD prophylaxis is safe and produced similar results as conventional prophylaxis in patients with one antigen HLA-MMUD HCT.

Authors+Show Affiliations

Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26947769

Citation

Mehta, Rohtesh S., et al. "Post-transplantation Cyclophosphamide Versus Conventional Graft-versus-host Disease Prophylaxis in Mismatched Unrelated Donor Haematopoietic Cell Transplantation." British Journal of Haematology, vol. 173, no. 3, 2016, pp. 444-55.
Mehta RS, Saliba RM, Chen J, et al. Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation. Br J Haematol. 2016;173(3):444-55.
Mehta, R. S., Saliba, R. M., Chen, J., Rondon, G., Hammerstrom, A. E., Alousi, A., Qazilbash, M., Bashir, Q., Ahmed, S., Popat, U., Hosing, C., Khouri, I., Shpall, E. J., Champlin, R. E., & Ciurea, S. O. (2016). Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation. British Journal of Haematology, 173(3), 444-55. https://doi.org/10.1111/bjh.13977
Mehta RS, et al. Post-transplantation Cyclophosphamide Versus Conventional Graft-versus-host Disease Prophylaxis in Mismatched Unrelated Donor Haematopoietic Cell Transplantation. Br J Haematol. 2016;173(3):444-55. PubMed PMID: 26947769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation. AU - Mehta,Rohtesh S, AU - Saliba,Rima M, AU - Chen,Julianne, AU - Rondon,Gabriela, AU - Hammerstrom,Aimee E, AU - Alousi,Amin, AU - Qazilbash,Muzaffar, AU - Bashir,Qaiser, AU - Ahmed,Sairah, AU - Popat,Uday, AU - Hosing,Chitra, AU - Khouri,Issa, AU - Shpall,Elizabeth J, AU - Champlin,Richard E, AU - Ciurea,Stefan O, Y1 - 2016/03/07/ PY - 2015/11/16/received PY - 2015/12/21/accepted PY - 2016/3/8/entrez PY - 2016/3/8/pubmed PY - 2017/5/4/medline KW - GVHD KW - HLA-mismatched transplantation KW - MMUD KW - post transplantation cyclophosphamide KW - unrelated donor SP - 444 EP - 55 JF - British journal of haematology JO - Br J Haematol VL - 173 IS - 3 N2 - Post-transplantation cyclophosphamide (PTCy) is an effective strategy to prevent graft-versus-host disease (GVHD) after haploidentical haematopoietic cell transplantation (HCT). We determined the efficacy of PTCy-based GVHD prophylaxis in human leucocyte antigen (HLA)-mismatched unrelated donor (MMUD) HCT. We analysed 113 adult patients with high-risk haematological malignancies who underwent one-antigen MMUD transplantation between 2009 and 2013. Of these, 41 patients received PTCy, tacrolimus and mycophenolate mofetil (MMF) for GVHD prophylaxis; 72 patients received conventional prophylaxis with anti-thymocyte globulin, tacrolimus and methotrexate. Graft source was primarily bone marrow (83% PTCy vs. 63% conventional group). Incidence of grade II-IV (37% vs. 36%, P = 0·8) and grade III-IV (17% vs. 12%, P = 0·5) acute GVHD was similar at day 100. However, the incidence of grade II-IV acute GVHD by day 30 was significantly lower in the PTCy group (0% vs. 15%, P = 0·01). Median time to neutrophil (18 days vs. 12 days, P < 0·001) and platelet (25·5 days vs. 18 days, P = 0·05) engraftment was prolonged in PTCy group. Rates of graft failure, chronic GVHD, 2-year non-relapse mortality, relapse, progression-free survival or overall survival were similar. Our results demonstrate that PTCy, tacrolimus and MMF for GVHD prophylaxis is safe and produced similar results as conventional prophylaxis in patients with one antigen HLA-MMUD HCT. SN - 1365-2141 UR - https://www.unboundmedicine.com/medline/citation/26947769/Post_transplantation_cyclophosphamide_versus_conventional_graft_versus_host_disease_prophylaxis_in_mismatched_unrelated_donor_haematopoietic_cell_transplantation_ L2 - https://doi.org/10.1111/bjh.13977 DB - PRIME DP - Unbound Medicine ER -