Post-Transplantation Cyclophosphamide and Tacrolimus for Graft-versus-Host Disease Prevention after Allogeneic Hematopoietic Cell Transplantation from HLA-Matched Donors Has More Advantages Than Limitations

This study compared the efficacy of graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) and tacrolimus (Tac) versus other regimens in 272 adults undergoing peripheral blood (PB) allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched donor...

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Autores: Salas, María Queralt|||0000-0003-4567-3682, Pedraza, Alexandra|||0000-0002-6039-8140, Charry, Paola|||0000-0002-4777-9643, Suárez-Lledó Grande, María|||0009-0004-4573-0581, Rodríguez Lobato, Luis Gerardo|||0000-0001-5694-0921, Brusosa, M.|||0009-0000-5336-3751, Solano, María Teresa, Serrahima, Anna|||0000-0002-7487-5358, Nomdedeu, Meritxell, Cid, Joan|||0000-0001-5445-4508, Lozano, Miquel|||0000-0003-2593-833X, Arcarons, Jordi|||0000-0002-1356-6260, de Llobet, Noemí|||0009-0004-3515-5632, Rosiñol, Laura|||0000-0002-2534-9239, Esteve Reyner, Jordi|||0000-0002-8056-648X, Urbano Ispizua, Álvaro|||0000-0002-7529-9399, Carreras, E., Fernandez Aviles, Francesc|||0000-0003-3051-3926, Rovira, Montserrat, Martínez, Carmen|||0000-0002-8401-7306
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311606
Acceso en línea:https://ddd.uab.cat/record/311606
https://dx.doi.org/urn:doi:10.1016/j.jtct.2023.11.020
Access Level:acceso abierto
Palabra clave:Allogeneic stem cell transplantation
Matched related donor
Matched unrelated donor
PTCy/Tac
Peripheral blood stem cell grafts
Post-transplantation cyclophosphamide
Tacrolimus
Descripción
Sumario:This study compared the efficacy of graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) and tacrolimus (Tac) versus other regimens in 272 adults undergoing peripheral blood (PB) allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched donors. Of these 272 patients, 95 (34.9%) received PTCy/Tac. The times to neutrophil and platelet engraftment were longer in the PTCy/Tac group (20 days versus 16 days for neutrophils and 19 days versus 12 days for platelets). The day +30 cumulative incidence (CuI) of bacterial bloodstream infection was higher in the PTCy/Tac group (43.2% versus 13.0%; P <.001). The CuIs of grade II-IV and grade III-IV acute GVHD (aGVHD) at day +180 were 14.7% and 4.2%, and the CuI of moderate/severe cGVHD at 2 years was 2.4% in the PTCy/Tac group and 41.8% (hazard ratio [HR],.29; P <.001), 15.8%, (HR,.24; P =.007), and 47.0% (HR,.05; P <.001), respectively, in the no-PTCy group. The duration of immunosuppression was shorter in patients receiving PTCy/Tac (6.2 months versus 9.0 months; P <.001). PTCy/Tac patients had higher OS (2 years: 74.3% versus 60.9%; HR,.54; P =.012), lower NRM (2 years: 8.6% versus 15.8%; HR,.54; P =.11), comparable CuI of relapse (2 years: 26.0% versus 24.4%; HR, 1.03; P =.89), and higher GRFS (2 years: 59.1% versus 16.7%; HR,.32; P <.001). Using PTCy/Tac in HLA-matched PB allo-HCT improved transplantation outcomes at out institution compared with previous prophylactic regimens, including a higher probability of survival despite more delayed engraftment and a higher rate of bacterial infection.

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