Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study

Allogeneic haematopoietic cell transplantation (alloHCT) remains a potentially curative strategy for relapsed or refractory lymphoid malignancies, even in the post-chimeric antigen receptor T-cell and bispecific antibody era. While reduced-intensity conditioning regimens offer lower non-relapse mort...

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Authors: Peña M, Lazzari L, Martínez DF, Ciceri F, Balaguer-Roselló A, Sanz J, Pascual MJ, Benzaquén A, Piñana JL, Salas MQ, Nieto-Vazquez A, Español I, Huguet M, Bento L, Saez AJ, Barba P, Filaferro S, Carbonell Asins JA, Peña C, Mussetti A, Greco R
Format: article
Status:Published version
Publication Date:2026
Country:España
Institution:INCLIVA
Repository:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20742
Online Access:https://incliva.portalinvestigacion.com/publicaciones/20742
Access Level:Open access
Keyword:allogeneic haematopoietic cell transplantation
lymphoid malignancies
post-transplant cyclophosphamide
reduced-intensity conditioning
treosulfan/fludarabine
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spelling Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC studyPeña MLazzari LMartínez DFCiceri FBalaguer-Roselló ASanz JPascual MJBenzaquén APiñana JLSalas MQNieto-Vazquez AEspañol IHuguet MBento LSaez AJBarba PFilaferro SCarbonell Asins JAPeña CMussetti AGreco Rallogeneic haematopoietic cell transplantationlymphoid malignanciespost-transplant cyclophosphamidereduced-intensity conditioningtreosulfan/fludarabineAllogeneic haematopoietic cell transplantation (alloHCT) remains a potentially curative strategy for relapsed or refractory lymphoid malignancies, even in the post-chimeric antigen receptor T-cell and bispecific antibody era. While reduced-intensity conditioning regimens offer lower non-relapse mortality (NRM), relapse rates remain high, and optimal conditioning strategies in the setting of post-transplant cyclophosphamide (PTCy) prophylaxis remain undefined. In this retrospective, international multicentre study, the primary end-point was NRM. We compared treosulfan/fludarabine (Treo/Flu) versus thiotepa/busulfan/fludarabine (TBF) in 178 adults with lymphoid malignancies undergoing first alloHCT with PTCy and peripheral blood grafts. Three-year NRM was 14.0% with Treo/Flu versus 33.0% with TBF. On multivariate analysis, Treo/Flu was associated with significantly lower 3-year NRM (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.22-0.87; p = 0.018). Conditioning regimen was not independently associated with overall survival (OS) or progression-free survival (PFS), and relapse incidence was similar between regimens. Moderate to severe chronic graft-versus-host disease (GVHD) was higher with Treo/Flu (26.0% vs. 9.9%; HR 2.43; 95% CI, 1.09-5.43; p = 0.03), while GVHD-free/relapse-free survival (GFRS) was comparable. Findings were consistent in a prespecified propensity score-matched sensitivity analysis. These findings support Treo/Flu as a potentially safer reduced-toxicity conditioning option than TBF in the context of PTCy-based GVHD prophylaxis for lymphoid malignancies and warrant prospective validation.WILEY2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/20742BRITISH JOURNAL OF HAEMATOLOGYISSN: 00071048ISSNe: 13652141reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p207422026-06-07T16:35:31Z
dc.title.none.fl_str_mv Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
title Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
spellingShingle Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
Peña M
allogeneic haematopoietic cell transplantation
lymphoid malignancies
post-transplant cyclophosphamide
reduced-intensity conditioning
treosulfan/fludarabine
title_short Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
title_full Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
title_fullStr Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
title_full_unstemmed Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
title_sort Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
dc.creator.none.fl_str_mv Peña M
Lazzari L
Martínez DF
Ciceri F
Balaguer-Roselló A
Sanz J
Pascual MJ
Benzaquén A
Piñana JL
Salas MQ
Nieto-Vazquez A
Español I
Huguet M
Bento L
Saez AJ
Barba P
Filaferro S
Carbonell Asins JA
Peña C
Mussetti A
Greco R
author Peña M
author_facet Peña M
Lazzari L
Martínez DF
Ciceri F
Balaguer-Roselló A
Sanz J
Pascual MJ
Benzaquén A
Piñana JL
Salas MQ
Nieto-Vazquez A
Español I
Huguet M
Bento L
Saez AJ
Barba P
Filaferro S
Carbonell Asins JA
Peña C
Mussetti A
Greco R
author_role author
author2 Lazzari L
Martínez DF
Ciceri F
Balaguer-Roselló A
Sanz J
Pascual MJ
Benzaquén A
Piñana JL
Salas MQ
Nieto-Vazquez A
Español I
Huguet M
Bento L
Saez AJ
Barba P
Filaferro S
Carbonell Asins JA
Peña C
Mussetti A
Greco R
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv allogeneic haematopoietic cell transplantation
lymphoid malignancies
post-transplant cyclophosphamide
reduced-intensity conditioning
treosulfan/fludarabine
topic allogeneic haematopoietic cell transplantation
lymphoid malignancies
post-transplant cyclophosphamide
reduced-intensity conditioning
treosulfan/fludarabine
description Allogeneic haematopoietic cell transplantation (alloHCT) remains a potentially curative strategy for relapsed or refractory lymphoid malignancies, even in the post-chimeric antigen receptor T-cell and bispecific antibody era. While reduced-intensity conditioning regimens offer lower non-relapse mortality (NRM), relapse rates remain high, and optimal conditioning strategies in the setting of post-transplant cyclophosphamide (PTCy) prophylaxis remain undefined. In this retrospective, international multicentre study, the primary end-point was NRM. We compared treosulfan/fludarabine (Treo/Flu) versus thiotepa/busulfan/fludarabine (TBF) in 178 adults with lymphoid malignancies undergoing first alloHCT with PTCy and peripheral blood grafts. Three-year NRM was 14.0% with Treo/Flu versus 33.0% with TBF. On multivariate analysis, Treo/Flu was associated with significantly lower 3-year NRM (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.22-0.87; p = 0.018). Conditioning regimen was not independently associated with overall survival (OS) or progression-free survival (PFS), and relapse incidence was similar between regimens. Moderate to severe chronic graft-versus-host disease (GVHD) was higher with Treo/Flu (26.0% vs. 9.9%; HR 2.43; 95% CI, 1.09-5.43; p = 0.03), while GVHD-free/relapse-free survival (GFRS) was comparable. Findings were consistent in a prespecified propensity score-matched sensitivity analysis. These findings support Treo/Flu as a potentially safer reduced-toxicity conditioning option than TBF in the context of PTCy-based GVHD prophylaxis for lymphoid malignancies and warrant prospective validation.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/20742
url https://incliva.portalinvestigacion.com/publicaciones/20742
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv BRITISH JOURNAL OF HAEMATOLOGY
ISSN: 00071048
ISSNe: 13652141
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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