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Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant.
Haematologica. 2017 02; 102(2):401-410.H

Abstract

Severe graft-versus-host disease is a major barrier for non-T-cell-depleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received post-transplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95%CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95%CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95%CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulin-based group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95%CI: 0.98-2.09); P=0.06] for post-transplant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with non-relapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus-host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and non-relapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia.

Authors+Show Affiliations

Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France annalisa.ruggeri@aphp.fr.Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France. INSERM, UMRs 938, Paris, France.Ospedale San Martino, Department of Haematology II, Genova, Italy.Ospedale San Raffaele, Haematology and BMT, Milano, Italy.Tor Vergata University, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy.Ospedale Civile Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy.Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey.Programme de Transplantation & Therapie Cellulaire, Institut Paoli Calmettes, Marseille, France.Centro Unico Regionale Trapianti, Alberto Neri, Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.Shariati Hospital, Hematology-Oncology and BMT Research, Teheran, Iran.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.A.O.U Citta della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy.Instituto de Investigacion Sanitaria Gregorio Marañon, Division of Hematology, Hospital Gregorio Marañon, Madrid, Spain.Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey.Ospedale San Raffaele, Haematology and BMT, Milano, Italy.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France. INSERM, UMRs 938, Paris, France. Université Pierre et Marie Curie, Paris, France.Université Pierre et Marie Curie, Paris, France. Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Tel Aviv University (TAU), Israel. EBMT Paris Office, Hospital Saint Antoine, Paris, France.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27758821

Citation

Ruggeri, Annalisa, et al. "Post-transplant Cyclophosphamide Versus Anti-thymocyte Globulin as Graft- Versus-host Disease Prophylaxis in Haploidentical Transplant." Haematologica, vol. 102, no. 2, 2017, pp. 401-410.
Ruggeri A, Sun Y, Labopin M, et al. Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. Haematologica. 2017;102(2):401-410.
Ruggeri, A., Sun, Y., Labopin, M., Bacigalupo, A., Lorentino, F., Arcese, W., Santarone, S., Gülbas, Z., Blaise, D., Messina, G., Ghavamzadeh, A., Malard, F., Bruno, B., Diez-Martin, J. L., Koc, Y., Ciceri, F., Mohty, M., & Nagler, A. (2017). Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. Haematologica, 102(2), 401-410. https://doi.org/10.3324/haematol.2016.151779
Ruggeri A, et al. Post-transplant Cyclophosphamide Versus Anti-thymocyte Globulin as Graft- Versus-host Disease Prophylaxis in Haploidentical Transplant. Haematologica. 2017;102(2):401-410. PubMed PMID: 27758821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. AU - Ruggeri,Annalisa, AU - Sun,Yuqian, AU - Labopin,Myriam, AU - Bacigalupo,Andrea, AU - Lorentino,Francesca, AU - Arcese,William, AU - Santarone,Stella, AU - Gülbas,Zafer, AU - Blaise,Didier, AU - Messina,Giuseppe, AU - Ghavamzadeh,Ardeshi, AU - Malard,Florent, AU - Bruno,Benedetto, AU - Diez-Martin,Jose Luis, AU - Koc,Yener, AU - Ciceri,Fabio, AU - Mohty,Mohamad, AU - Nagler,Arnon, Y1 - 2016/10/06/ PY - 2016/06/29/received PY - 2016/09/30/accepted PY - 2016/10/21/pubmed PY - 2017/7/8/medline PY - 2016/10/21/entrez SP - 401 EP - 410 JF - Haematologica JO - Haematologica VL - 102 IS - 2 N2 - Severe graft-versus-host disease is a major barrier for non-T-cell-depleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received post-transplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95%CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95%CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95%CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulin-based group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95%CI: 0.98-2.09); P=0.06] for post-transplant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with non-relapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus-host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and non-relapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia. SN - 1592-8721 UR - https://www.unboundmedicine.com/medline/citation/27758821/Post_transplant_cyclophosphamide_versus_anti_thymocyte_globulin_as_graft__versus_host_disease_prophylaxis_in_haploidentical_transplant_ L2 - https://doi.org/10.3324/haematol.2016.151779 DB - PRIME DP - Unbound Medicine ER -