Graft-versus-Host Disease Prophylaxis with Post-Transplantation Cyclophosphamide versus Cyclosporine A and Methotrexate in Matched Sibling Donor Transplantation.

Abstract

Cyclosporine A (CSA) and methotrexate (MTX) is the standard graft-versus-host disease (GVHD) prophylaxis regimen for matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). Recently, post-transplantation cyclophosphamide (PTCy) has been shown to be effective in GVHD prevention. In this registry-based study, we compared outcomes of 118 patients treated with PTCy and 1202 patients with CSA/MTX who underwent MSD allo-HCT for acute myelogenous leukemia. In a matched-pair analysis, PTCy was associated with a higher incidence of relapse at 2 years compared with CSA/MTX (41.1% versus 21.3%; P = .039). The incidences of day +180 grade II-IV acute GVHD and 2-year chronic GVHD were comparable in the PTCy and CSA/MTX arms (25.2% versus 25.4% [P = .90] and 42.6% versus 42.6% [P = .84], respectively). Similarly, 2-year leukemia-free survival (LFS; 54.4% versus 74.32%; P = .052), overall survival (OS; 70.6% versus 79.7%; P = .15), and GVHD-free relapse-free survival (GRFS; 38.1% versus 52.5%; P = .49) were not statistically different in the 2 arms. Our data show that GVHD prophylaxis with PTCy is feasible, resulting in similar incidences of GVHD, GRFS, LFS, and OS as seen with conventional CSA/MTX in patients undergoing allo-HCT from an MSD. The higher rate of relapse observed with PTCy needs further evaluation in a prospective study. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

• Authors: Arnon Nagler, Myriam Labopin, Bhagirathbhai Dholaria, Depei Wu, Goda Choi, Mahmoud Aljurf, Fabio Ciceri, Tobias Gedde-Dahl, Ellen Meijer, Riitta Niittyvuopio, Sergey Bondarenko, Jean Henri Bourhis, Jan J Cornelissen, Gerard Socié, Yener Koc, Jonathan Canaani, Bipin Savani, Gesine Bug, Alexandros Spyridonidis, Sebastian Giebel, Eolia Brissot, Ali Bazarbachi, Jordi Esteve, Mohamad Mohty
• Journal: Transplantation and cellular therapy (Transplant Cell Ther) Vol. 28 Issue 2 Pg. 86.e1-86.e8 (02 2022) ISSN: 2666-6367 [Electronic] United States
• PMID: 34856420 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Cyclosporine
• Cyclophosphamide
• Methotrexate

Topics

• Cyclophosphamide (therapeutic use)
• Cyclosporine (therapeutic use)
• Graft vs Host Disease (epidemiology)
• Humans
• Leukemia, Myeloid, Acute (drug therapy)
• Methotrexate (therapeutic use)
• Prospective Studies
• Recurrence
• Siblings
• Transplantation Conditioning (methods)
• United States