Sequence matters: Total body irradiation (TBI)-based myeloablative conditioning with post-transplant cyclophosphamide may reduce the early nonrelapse mortality compared with pretransplant cyclophosphamide plus TBI
Por:
Redondo, S, Garcia-Cadenas, I, Vila, A, Esquirol, A, Portos, JM, Novelli, S, Saavedra, S, Moreno, C, Garrido, A, Arguello-Tomas, M, Onate, G, Lopez-Pardo, J, Caballero, AC, Miqueleiz, S, Briones, J, Sierra, J, Sancho, G, Martino, R
Publicada:
14 abr 2023
Ahead of Print:
1 abr 2023
Resumen:
Objectives: High-dose total body irradiation (TBI) is considered a cornerstone of myeloablative conditioning for allogeneic stem cell transplantation (allo-SCT). We retrospectively compared the main outcomes of an HLA matched or 1-allele mismatched related or unrelated allo-SCT in adult patients affected by acute leukemia (AL) or myelodysplastic syndromes (MDS).
Methods: Fifty-nine patients received cyclophosphamide (Cy)-TBI (13.5 Gy) and graft-versus-host disease (GVHD) prophylaxis with a calcineurin-inhibitor plus methrotrexate (CyTBI group) and 28 patients received fludarabine-TBI (8.8-13.5 Gy) and GVHD prophylaxis with PTCy and tacrolimus (FluTBI-PTCy group).
Results: Median follow-up for survivors was 82 and 22 months. The 12-month probability of overall survival and progression-free survival were similar (p =.18, p =.7). The incidence of Grades 2-4 and 3-4 acute GVHD, and the incidence of moderate-to-severe chronic GVHD were higher in the CyTBI group (p =.02, p <.01 and p =.03). Nonrelapse mortality (NRM) at 12 months posttransplant was higher in the CyTBI group (p = 0.05), while the incidence of relapse was similar in both groups (p = 0.7). The number of GVHD-free and relapse-free patients without systemic immunosuppression (GRFS) at 1-year posttransplant was higher in the FluTBI-PTCy group (p = 0.01).
Conclusions: The study confirms the safety and efficacy of a novel FluTBI-PTCy platform with reduced incidence of severe acute and chronic GVHD, and early improvement of NRM.
Filiaciones:
Redondo, S:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Garcia-Cadenas, I:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Vila, A:
Hosp Santa Creu & Sant Pau, Radiotherapy Oncol Dept, Barcelona, Spain
Esquirol, A:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Portos, JM:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Novelli, S:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Saavedra, S:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Moreno, C:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Garrido, A:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Arguello-Tomas, M:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Onate, G:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Lopez-Pardo, J:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Caballero, AC:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Miqueleiz, S:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Briones, J:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Sierra, J:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Sancho, G:
Hosp Santa Creu & Sant Pau, Radiotherapy Oncol Dept, Barcelona, Spain
Martino, R:
Univ Autonoma Barcelona, Hosp St Creu & St Pau, Hematol Dept, IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Jose Carreras Leukemia Res Inst, Dept Med, Barcelona, Spain
Bronze, All Open Access; Bronze
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