Post-transplant cyclophosphamide and sirolimus based graft-versus-host disease prophylaxis after allogeneic stem cell transplantation for acute myeloid leukemia.

Abstract

Post-transplant cyclophosphamide (PTCy) has emerged as a promising graft-versus-host disease (GvHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, no studies have reported the efficacy of a GvHD prophylaxis based on PTCy with sirolimus (Sir-PTCy) in patients with acute myeloid leukemia (AML). In this retrospective study, we analyze the use of sirolimus in combination with PTCy, with or without mycophenolate mofetil (MMF), on 242 consecutive adult patients with AML undergoing a myeloablative first allo-HSCT from different donor types, in three European centers between January 2017 and December 2020. Seventy-seven (32%) patients received allo-HSCT from HLA-matched sibling donor, 101 (42%) from HLA-matched and mismatched unrelated donor, and 64 (26%) from haploidentical donor. Except for neutrophil and platelet engraftment, which was slower in the haploidentical cohort, no significant differences were observed in major transplant outcomes according to donor type in univariate and multivariate analysis. GvHD prophylaxis with Sir-PTCy, with or without MMF, is safe and effective in patients with AML undergoing myeloablative allo-HSCT, resulting in low rates of transplant-related mortality, relapse/progression, and acute and chronic GvHD in all donor settings.

• Authors: Lorenzo Lazzari, Aitana Balaguer-Roselló, Juan Montoro, Raffaella Greco, Rafael Hernani, Maria Teresa Lupo-Stanghellini, Marta Villalba, Fabio Giglio, Ana Facal, Francesca Lorentino, Manuel Guerreiro, Alessandro Bruno, Ariadna Pérez, Elisabetta Xue, Daniela Clerici, Simona Piemontese, José Luis Piñana, Miguel Ángel Sanz, Carlos Solano, Javier de la Rubia, Fabio Ciceri, Jacopo Peccatori, Jaime Sanz
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 57 Issue 9 Pg. 1389-1398 (09 2022) ISSN: 1476-5365 [Electronic] England
• PMID: 35680995 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Chemical References

• Cyclophosphamide
• Mycophenolic Acid
• Sirolimus

Topics

• Adult
• Cyclophosphamide (therapeutic use)
• Graft vs Host Disease
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Leukemia, Myeloid, Acute (drug therapy)
• Mycophenolic Acid (therapeutic use)
• Retrospective Studies
• Sirolimus (pharmacology, therapeutic use)
• Transplantation Conditioning (methods)
• Unrelated Donors