Incorporating posttransplant cyclophosphamide-based prophylaxis as standard-of-care outside the haploidentical setting: challenges and review of the literature
Por:
Garcia-Cadenas, I, Awol, R, Esquirol, A, Saavedra, S, Bosch-Vilaseca, A, Novelli, S, Garrido, A, Lopez, J, Granell, M, Moreno, C, Briones, J, Brunet, S, Sierra, J, Martino, R
Publicada:
1 jun 2020
Resumen:
Posttransplant high-dose cyclophosphamide (PTCy) effectively prevents GvHD after haploidentical SCT. However, its use in HLA-matched SCT has been less explored. Fifty-six consecutive patients who underwent allo-SCT for hematological malignancies have been included in this prospective single-center protocol. Donors have been HLA-identical siblings, fully-matched unrelated or 1-allele-mismatched unrelated donors in 30%, 32%, and 37% of cases, respectively. Nine patients have received a TBI-containing MAC regimen, while the remaining (84%) received RIC platforms based on Fludarabine plus Busulfan/Melphalan. Due to the high graft failure (GF) rate (21%) in a preliminary analysis in the allo-RIC cohort (n = 29), protocol amendments have been implemented, with no further cases of GF after the introduction of mini-thiotepa (0/18). The overall incidence of grade II-IV acute GvHD is 24% (95% CI: 17-31%) with four steroid-refractory cases. Severe chronic GvHD has occurred in only 1 of 43 evaluable cases. The 1-year NRM and relapse are 18% (95% CI: 12-26%) and 30% (18-42%) and the OS and DFS are 78% and 64%, respectively. These outcomes support the feasibility of using PTCy as a SOC outside the haplo-setting, albeit mini-thiotepa (3 mg/kg) was incorporated in the standard allo-RIC platforms to prevent GF. Despite the limitations of a single-center experience and the short follow-up, these protocols show promising results with particular benefit in reducing the occurrence of moderate-to-severe GvHD.
Filiaciones:
Garcia-Cadenas, I:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Awol, R:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Esquirol, A:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Saavedra, S:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Bosch-Vilaseca, A:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Novelli, S:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Garrido, A:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Lopez, J:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Granell, M:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Moreno, C:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Briones, J:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Brunet, S:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Sierra, J:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
Martino, R:
Autonomous Univ Barcelona, Dept Hematol, Hosp Santa Creu & St Pau, St Pau & Jose Carreras Leukemia Res Inst, Barcelona, Spain
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