Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT.
Adult
Aged
Cyclophosphamide
/ therapeutic use
Donor Selection
Female
Graft vs Host Disease
/ etiology
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Immunosuppressive Agents
/ therapeutic use
Leukemia, Myeloid, Acute
/ therapy
Male
Middle Aged
Retrospective Studies
Siblings
Tissue Donors
Transplantation, Haploidentical
/ adverse effects
Treatment Outcome
Young Adult
Acute leukemia
Allogeneic stem cell transplant
Alternative donor transplants
Haploidentical transplant
Post-transplant cyclophosphamide
Journal
Journal of hematology & oncology
ISSN: 1756-8722
Titre abrégé: J Hematol Oncol
Pays: England
ID NLM: 101468937
Informations de publication
Date de publication:
06 05 2020
06 05 2020
Historique:
received:
21
02
2020
accepted:
23
04
2020
entrez:
8
5
2020
pubmed:
8
5
2020
medline:
26
1
2021
Statut:
epublish
Résumé
The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy. We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9). The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
Sections du résumé
BACKGROUND
The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy.
METHODS
We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017.
RESULTS
The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9).
CONCLUSIONS
The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
Identifiants
pubmed: 32375860
doi: 10.1186/s13045-020-00882-6
pii: 10.1186/s13045-020-00882-6
pmc: PMC7201995
doi:
Substances chimiques
Immunosuppressive Agents
0
Cyclophosphamide
8N3DW7272P
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
46Références
Blood. 2010 Apr 22;115(16):3224-30
pubmed: 20124511
Lancet Oncol. 2009 Sep;10(9):855-64
pubmed: 19695955
N Engl J Med. 2009 Jul 30;361(5):478-88
pubmed: 19641204
Biol Blood Marrow Transplant. 2010 Apr;16(4):482-9
pubmed: 19925877
Leukemia. 2020 May;34(5):1433-1443
pubmed: 31831845
N Engl J Med. 2016 Jan 7;374(1):43-53
pubmed: 26735993
Biol Blood Marrow Transplant. 2019 Feb;25(2):270-278
pubmed: 30292009
Science. 2002 Mar 15;295(5562):2097-100
pubmed: 11896281
Eur J Haematol. 2018 May;100(5):395-402
pubmed: 29360184
Haematologica. 2018 Aug;103(8):1317-1328
pubmed: 29748438
J Clin Oncol. 2014 Nov 1;32(31):3497-505
pubmed: 25267759
Blood. 2010 Jul 22;116(3):354-65
pubmed: 20385793
Clin Cancer Res. 2016 Jul 15;22(14):3467-76
pubmed: 26927664
J Hematol Oncol. 2017 Jul 4;10(1):134
pubmed: 28676064
Bone Marrow Transplant. 2016 Apr;51(4):610-1
pubmed: 26657834
J Clin Oncol. 2017 Oct 20;35(30):3425-3432
pubmed: 28846465
Bone Marrow Transplant. 1995 Jun;15(6):825-8
pubmed: 7581076
Clin Cancer Res. 2018 Jun 15;24(12):2794-2803
pubmed: 29555662
Blood Adv. 2017 Feb 28;1(7):477-485
pubmed: 29296964
Biol Blood Marrow Transplant. 2013 Jan;19(1):117-22
pubmed: 22940057
J Hematol Oncol. 2018 Mar 15;11(1):40
pubmed: 29544522
J Clin Oncol. 2015 Oct 1;33(28):3152-61
pubmed: 26261255
Cancer. 2018 Apr 1;124(7):1428-1437
pubmed: 29360162
J Clin Oncol. 2009 Sep 20;27(27):4570-7
pubmed: 19652066
Cancer. 2016 Nov 15;122(21):3316-3326
pubmed: 27404668
J Clin Oncol. 2013 Apr 1;31(10):1310-6
pubmed: 23423745
Leukemia. 2015 Sep;29(9):1891-900
pubmed: 25882700
N Engl J Med. 2012 Oct 18;367(16):1487-96
pubmed: 23075175
Transplantation. 1974 Oct;18(4):295-304
pubmed: 4153799
J Clin Oncol. 2017 Sep 10;35(26):3002-3009
pubmed: 28644773
Blood. 2015 Jun 18;125(25):3956-62
pubmed: 25940714
Blood. 2015 Aug 20;126(8):1033-40
pubmed: 26130705
Blood Adv. 2019 Jun 25;3(12):1826-1836
pubmed: 31201170
Biol Blood Marrow Transplant. 2016 Jan;22(1):112-8
pubmed: 26343947
Biol Blood Marrow Transplant. 2008 Jun;14(6):641-50
pubmed: 18489989
J Clin Oncol. 2017 Apr 10;35(11):1154-1161
pubmed: 28380315
Leukemia. 2005 Dec;19(12):2304-12
pubmed: 16193083
Blood. 2016 Mar 17;127(11):1502-8
pubmed: 26764356
J Clin Oncol. 2006 Dec 20;24(36):5695-702
pubmed: 17116940
J Hematol Oncol. 2017 Jan 19;10(1):24
pubmed: 28103944