Post-transplantation cyclophosphamide GvHD prophylaxis after hematopoietic stem cell transplantation from 9/10 or 10/10 HLA-matched unrelated donors for acute leukemia.
Adolescent
Adult
Aged
Cyclophosphamide
/ therapeutic use
Female
Follow-Up Studies
Graft vs Host Disease
/ drug therapy
Hematopoietic Stem Cell Transplantation
/ adverse effects
Histocompatibility Testing
Humans
Immunosuppressive Agents
/ therapeutic use
Leukemia, Myeloid, Acute
/ mortality
Male
Middle Aged
Neoplasm Recurrence, Local
/ mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ mortality
Prognosis
Retrospective Studies
Survival Rate
Transplantation Conditioning
Transplantation, Homologous
Unrelated Donors
Young Adult
Journal
Leukemia
ISSN: 1476-5551
Titre abrégé: Leukemia
Pays: England
ID NLM: 8704895
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
18
09
2019
accepted:
01
05
2020
revised:
27
04
2020
pubmed:
16
5
2020
medline:
26
2
2021
entrez:
16
5
2020
Statut:
ppublish
Résumé
HLA-matching largely contributes to unrelated donor hematopoietic cell transplantation (UD-HCT) success but, due to the selective deletion of alloreactive T-cells, post-transplantation cyclophosphamide (PTCy) could modulate its negative impact on outcomes. We retrospectively compared acute leukemia patients receiving 10/10 or 9/10 HLA allele-matched UD-HCT with PTCy-GvHD prophylaxis between 2010 and 2017, reported to EBMT registry. The 100-day incidence of grade ≥2 and grade ≥3 aGvHD were comparable for 10/10 and 9/10 UD (28% versus 28%, p = 0.8 and 10% versus 8%, p = 0.5, respectively). The 2-year cGvHD and extensive cGvHD were similar between 10/10 and 9/10 UD (35% versus 44%, p = 0.2 and 21% versus 20%, p = 0.6, respectively). The 2-year nonrelapse mortality was 20% after 10/10 and 16% after 9/10 UD-HCT (p = 0.1). Relapse incidence at 2-year was 24% for 10/10 and 28% for 9/10 UD-HCT (p = 0.4). Leukemia-free survival at 2-year was the same for 10/10 and 9/10 UD (56 and 56%, p = 0.6, respectively), with comparable overall survival (62 and 59%, p = 0.9, respectively). Multivariate analysis showed no effect of HLA-matching on outcomes. An advanced disease status and patient disability remained the most important factors portending a worse survival. PTCy could alleviate the detrimental effect of HLA-allele mismatching in UD-HCT, potentially expanding the donor pool for acute leukemia patients.
Identifiants
pubmed: 32409688
doi: 10.1038/s41375-020-0863-4
pii: 10.1038/s41375-020-0863-4
doi:
Substances chimiques
Immunosuppressive Agents
0
Cyclophosphamide
8N3DW7272P
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
585-594Références
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