Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantation

• DOI: 10.1007/s00277-020-04317-7
• Publication Date: 2020-11-02T21:33:52Z
• Authors: Rebeca Bailén; Mi Kwon; María Jesús Pascu...; Christelle Ferrà; Jaime Sanz; Anabel Gallardo-M...; Abel García-Sola; Anna Torrent; María José Jiméne...; José Luis Piñana; Juan Montoro; Gillen Oarbeascoa; Nieves Dorado; Ignacio Gómez-Cen...; Cristina Muñoz; Carolina Martínez...; Javier Anguita; Ismael Buño; José Luis Díez-Ma...
• Keywords: Adult; Male; Peripheral Blood Stem Cell Transplantation; Adolescent; Incidence; Graft vs Host Disease; Middle Aged; Allografts; Disease-Free Survival; 3. Good health; Survival Rate; GVHD prophylaxis, Post-transplant cyclophosphamide, Unrelated donor HSCT; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Unrelated Donors; Cyclophosphamide; Aged; Antilymphocyte Serum; Follow-Up Studies; Retrospective Studies

Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLA-haploidentical HSCT. The use of PTCY in the unrelated donor HSCT setting is less explored. We conducted a retrospective study of 132 consecutive patients undergoing a matched or 9/10 mismatched unrelated donor HSCT in 4 centers in Spain, 60 with anti-thymocyte globulin (ATG)-based prophylaxis combined with MTX-CsA, and 72 using a PTCY-based regimen. Peripheral blood stem cells were used as graft in most patients (111 patients, 84%); mMUD donors were balanced between groups. Cumulative incidences of grades II-IV and III-IV acute GVHD at 100 days were lower in the PTCy group (46% vs. 67%, p = 0.008; 3% vs. 34%, p = 0.003), without statistically significant differences in the 2-year cumulative incidence of chronic moderate-severe GVHD. At 2 years, no significant differences were observed in overall survival, event-free survival, cumulative incidence of relapse, and non-relapse mortality. GVHD was the most frequent cause of NRM in the ATG group. No differences were observed between groups in the composite endpoint of GVHD-free and relapse-free survival. In this study, PTCy combined with additional immunosuppression after MUD/mMUD HSCT showed a reduction of aGVHD rate with safety results comparable to those obtained with the ATG-based prophylaxis.