Reduced post-transplant cyclophosphamide dose with antithymocyte globulin in peripheral blood stem cell haploidentical transplantation.
Aged
Humans
Antilymphocyte Serum
/ therapeutic use
Peripheral Blood Stem Cells
Transplantation, Haploidentical
Neoplasm Recurrence, Local
/ drug therapy
Cyclophosphamide
/ therapeutic use
Peripheral Blood Stem Cell Transplantation
Hematopoietic Stem Cell Transplantation
Graft vs Host Disease
/ pathology
Transplantation Conditioning
Retrospective Studies
Journal
Bone marrow transplantation
ISSN: 1476-5365
Titre abrégé: Bone Marrow Transplant
Pays: England
ID NLM: 8702459
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
06
05
2023
accepted:
09
08
2023
revised:
01
08
2023
medline:
6
11
2023
pubmed:
19
8
2023
entrez:
18
8
2023
Statut:
ppublish
Résumé
Post-transplant cyclophosphamide (PT-Cy) is effective for graft-versus-host disease (GVHD) prophylaxis, but it may cause dose-dependent toxicities, particularly in frail patients. Therefore, we compared the outcomes with a reduced PT-Cy total dose (70 mg/kg) to those with the standard PT-Cy dose (100 mg/kg) in haploidentical hematopoietic cell transplantation (HCT) patients aged ≥ 65 years and those with cardiac comorbidities. All consecutive patients with a hematological malignancy receiving peripheral blood stem cells (PBSCs) after a thiotepa-based conditioning with low-dose antithymocyte globulin were included. Thirty-three patients received PT-Cy at 70 mg/kg and 25 at 100 mg/kg. PT-Cy dose reduction did not increase the risk of GVHD and was associated with faster neutrophil and platelet recovery, and lower cumulative incidences of bacteremia (38% versus 72%, p = 0.004) and cardiac complications (12% versus 44%, p = 0.028). At 2 years, GVHD-free, relapse-free survival (GRFS) was higher with the reduced dose compared to the standard dose (60% versus 33%, p = 0.04). In conclusion, reducing PT-Cy total dose to 70 mg/kg is a safe and valid approach for elderly patients and those with cardiac comorbidities underdoing haploidentical HCT with PBSCs and low-dose antithymocyte globulin. The reduced PT-Cy dose was associated with improved hematological count recovery, lower incidence of toxicities, and higher GRFS.
Identifiants
pubmed: 37596473
doi: 10.1038/s41409-023-02085-2
pii: 10.1038/s41409-023-02085-2
doi:
Substances chimiques
Antilymphocyte Serum
0
Cyclophosphamide
8N3DW7272P
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1215-1222Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature Limited.
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