Post-transplant Cyclophosphamide and Tacrolimus for GVHD Prevention Allo-HCT from HLA-Matched Donors Generates more Advantages than Limitations.

This study compares the efficacy of PTCY/Tac vs. other prophylaxis in 272 adults undergoing peripheral blood (PB) allo-HCT from HLA-matched donors. 95 (34.9%) adults received PTCY/Tac. Time to neutrophil and platelet engraftment was longer in the PTCY/Tac group (20 vs. 16 days and 19 vs. 12 days). The day +30 cumulative incidence of bacterial bloodstream infection was higher in the PTCY/Tac group (43.2% vs. 13.0%, P<0.001). The cumulative incidences of grade II-IV and III-IV aGVHD at day +180 and of moderate/severe cGVHD at 2 years were 14.7%, 4.2%, and 2.4% for patients receiving PTCY/Tac, and 41.8% (HR 0.29, P<0.001), 15.8%, (HR 0.24, P=0.007) and 47.0% (HR 0.05, P<0.001) for those who did not. Immunosuppression duration was shorter in patients receiving PTCY/Tac (6.2 vs. 9.0 months, P<0.001). PTCY/Tac patients had higher OS (2-years: 74.3 vs. 60.9%, HR 0.54, P=0.012), lower NRM (2-years: 8.6% vs. 15.8%; HR 0.54, P=0.11), comparable CIR (2-years: 26.0% vs. 24.4%, HR 1.03, P=0.89), and higher GRFS (2-years: 59.1% vs. 16.7%; HR 0.32, P<0.001). Using PTCY/Tac in HLA-matched PB allo-HCT improved transplant outcomes at out institution, compared with that of previous prophylaxis, including higher probability of survival in spite of more delayed engraftment and higher bacterial infections.

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Declaration of Competing Interest The authors declare no relevant conflicts of interest, financial or otherwise.