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Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT.
J Hematol Oncol. 2020 05 06; 13(1):46.JH

Abstract

BACKGROUND

The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy.

METHODS

We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017.

RESULTS

The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9).

CONCLUSIONS

The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.

Authors+Show Affiliations

Hematology Department, Hospital Universitari i Politècnic La Fe, Avinguda Fernando Abril Martorell, 106, 46026, Valencia, Spain. sanz_jai@gva.es. CIBERONC, Instituto Carlos III, Madrid, Spain. sanz_jai@gva.es.EBMT Paris Office, Hospital Saint Antoine, Paris, France.EBMT Paris Office, Hospital Saint Antoine, Paris, France. Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France.First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia.Department of Haematology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.Haematology and BMT, Ospedale San Raffaele s.r.l., Milano, Italy.Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France.Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.Department of Hematology (Br 250), VU University Medical Center, Amsterdam, The Netherlands.Hematology Department, Hospital GU Gregorio Marañon, Instituto de Investigación sanitaria Gregorio Marañon, Universidad Complutense Madrid, Madrid, Spain.Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey.Dept. of Hematology, Institute of Hematology & Oncology, Hospital Clinic, Barcelona, Spain. Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Institut Josep Carreras, University of Barcelona, Barcelona, Spain.Transplantation Unit, Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy.Vanderbilt University Medical Center, Nashville, TN, USA.Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Rome, Italy.Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel. ALWP of the EBMT office, Saint Antoine Hospital, Paris, France.Department of Hematology, Hopital Saint Antoine, Sorbonne University, Paris, France.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32375860

Citation

Sanz, Jaime, et al. "Post-transplant Cyclophosphamide After Matched Sibling, Unrelated and Haploidentical Donor Transplants in Patients With Acute Myeloid Leukemia: a Comparative Study of the ALWP EBMT." Journal of Hematology & Oncology, vol. 13, no. 1, 2020, p. 46.
Sanz J, Galimard JE, Labopin M, et al. Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. J Hematol Oncol. 2020;13(1):46.
Sanz, J., Galimard, J. E., Labopin, M., Afanasyev, B., Angelucci, E., Ciceri, F., Blaise, D., Cornelissen, J. J., Meijer, E., Diez-Martin, J. L., Koc, Y., Rovira, M., Castagna, L., Savani, B., Ruggeri, A., Nagler, A., & Mohty, M. (2020). Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. Journal of Hematology & Oncology, 13(1), 46. https://doi.org/10.1186/s13045-020-00882-6
Sanz J, et al. Post-transplant Cyclophosphamide After Matched Sibling, Unrelated and Haploidentical Donor Transplants in Patients With Acute Myeloid Leukemia: a Comparative Study of the ALWP EBMT. J Hematol Oncol. 2020 05 6;13(1):46. PubMed PMID: 32375860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. AU - Sanz,Jaime, AU - Galimard,Jacques-Emmanuel, AU - Labopin,Myriam, AU - Afanasyev,Boris, AU - Angelucci,Emanuele, AU - Ciceri,Fabio, AU - Blaise,Didier, AU - Cornelissen,Jan J, AU - Meijer,Ellen, AU - Diez-Martin,J L, AU - Koc,Yener, AU - Rovira,Montserrat, AU - Castagna,Luca, AU - Savani,Bipin, AU - Ruggeri,Annalisa, AU - Nagler,Arnon, AU - Mohty,Mohamad, AU - ,, Y1 - 2020/05/06/ PY - 2020/02/21/received PY - 2020/04/23/accepted PY - 2020/5/8/entrez PY - 2020/5/8/pubmed PY - 2020/5/8/medline KW - Acute leukemia KW - Allogeneic stem cell transplant KW - Alternative donor transplants KW - Haploidentical transplant KW - Post-transplant cyclophosphamide SP - 46 EP - 46 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 13 IS - 1 N2 - BACKGROUND: The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy. METHODS: We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. RESULTS: The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/32375860/Post-transplant_cyclophosphamide_after_matched_sibling,_unrelated_and_haploidentical_donor_transplants_in_patients_with_acute_myeloid_leukemia:_a_comparative_study_of_the_ALWP_EBMT L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-020-00882-6 DB - PRIME DP - Unbound Medicine ER -
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