Tacrolimus plus sirolimus with or without ATG as GVHD prophylaxis in HLA-mismatched unrelated donor allogeneic stem cell transplantation
Por:
Kharfan-Dabaja, MA, Parody, R, Perkins, J, Lopez-Godino, O, Lopez-Corral, L, Vazquez, L, Caballero, D, Falantes, J, Shapiro, J, Orti, G, Barba, P, Valcarcel, D, Esquirol, A, Martino, R, Pinana, JL, Solano, C, Tsalatsanis, A, Pidala, J, Anasetti, C, Perez-Simon, JA
Publicada:
1 mar 2017
Resumen:
HLA-matched related or unrelated donors are not universally available. Consequently, patients can be offered hematopoietic stem cell transplantation (HSCT) from alternative donors, including mismatched unrelated donors (MMURD), known to cause a higher incidence of acute GVHD (aGVHD) and chronic GVHD. In vivo T-cell-depletion strategies, such as antithymocyte globulin (ATG) therapy, significantly decrease the risk of GVHD. We performed a multicenter, retrospective study comparing tacrolimus (TAC) and sirolimus (SIR) with or without ATG in 104 patients (TAC-SIR = 45, TAC-SIR-ATG = 59) who underwent MMURD HSCT. Use of ATG was associated with a lower incidence, albeit not statistically significant, of grades 2-4 aGVHD (46% vs 64%, P= 0.09), no difference in grades 3-4 aGVHD (10% vs 15%, P= 0.43), a trend for a lower incidence of moderate/severe chronic GVHD (16% vs 37%, P= 0.09) and more frequent Epstein-Barr virus reactivation (54% vs 18%, P= 0.0002). There were no statistically significant differences in 3-year overall survival (OS) (TAC-SIR-ATG = 40% (95% confidence interval (CI) = 24-56%) vs TAC-SIR = 54% (95% CI = 37-70%), P= 0.43) or 3-year cumulative incidence of relapse/progression (TAC-SIR-ATG = 40% (95% CI = 28-58%) vs TAC-SIR = 22% (95% CI = 13-39%), P= 0.92). An intermediate Center for International Blood & Marrow Transplant Research disease risk resulted in a significantly lower non-relapse mortality and better OS at 3 years. Our study suggests that addition of ATG to TAC-SIR in MMURD HSCT does not affect OS when compared with TAC-SIR alone.
Filiaciones:
Kharfan-Dabaja, MA:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Parody, R:
Hosp Univ Virgen Rocio, Dept Hematol, Inst Biomed Sevilla IBIS CSIC, Seville, Spain
Perkins, J:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Univ S Florida, Coll Pharm, Tampa, FL USA
Lopez-Godino, O:
Hosp Univ Salamanca, Salamanca, Spain
Lopez-Corral, L:
Hosp Univ Salamanca, Salamanca, Spain
Vazquez, L:
Hosp Univ Salamanca, Salamanca, Spain
Caballero, D:
Hosp Univ Salamanca, Salamanca, Spain
Falantes, J:
Hosp Univ Virgen Rocio, Dept Hematol, Inst Biomed Sevilla IBIS CSIC, Seville, Spain
Shapiro, J:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Orti, G:
Hosp Univ Vall dHebron, Barcelona, Spain
Barba, P:
Hosp Univ Vall dHebron, Barcelona, Spain
Valcarcel, D:
Hosp Univ Vall dHebron, Barcelona, Spain
Esquirol, A:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Martino, R:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Pinana, JL:
Hosp Clin Valenci, Valencia, Spain
Solano, C:
Hosp Clin Valenci, Valencia, Spain
Tsalatsanis, A:
Univ S Florida, Coll Med, Ctr Evidence Based Med, Tampa, FL USA
Pidala, J:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Anasetti, C:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Perez-Simon, JA:
Hosp Univ Virgen Rocio, Dept Hematol, Inst Biomed Sevilla IBIS CSIC, Seville, Spain
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