Improved GRFS after posttransplant cyclophosphamide-based vs ATG-based HLA-mismatched unrelated donor transplant Journal Article
| Authors: | Jimenez, A. J.; Komanduri, K.; Brown, S.; Wang, T.; Pereira, D.; Goodman, M.; Beitinjaneh, A.; Lekakis, L.; Chinapen, S.; Devlin, S.; Ponce, D.; Sauter, C.; Perales, M. A.; Shaffer, B. C. |
| Article Title: | Improved GRFS after posttransplant cyclophosphamide-based vs ATG-based HLA-mismatched unrelated donor transplant |
| Abstract: | A common method to prevent graft-versus-host disease after allogeneic hematopoietic cell transplantation (HCT) from an HLA-mismatched unrelated donor (MMUD) is tacrolimus, methotrexate, and antithymocyte globulin (ATG). The use of posttransplant cyclophosphamide (PTCy) showed promise in a prospective trial for MMUD HCT. We compared 1-year graft-versus-host disease–free, relapse-free survival (GRFS) in 128 recipients of prophylaxis based on tacrolimus/methotrexate/ATG (ATG group, n 5 46) vs PTCy, mycophenolate mofetil, and tacrolimus or sirolimus (PTCy group, n 5 82) after MMUD HCT. Patients receiving HCT from a MMUD mismatched at $1 locus among HLA-A, HLA-B, HLA-C, and HLA-DRB1 were included. The 2 groups were well matched for HCT indication, high-risk disease, and HCT comorbidity index, whereas more patients on PTCy received bone marrow (50% vs 26%; P 5 .01) and .1 locus HLA-mismatched (30.5% vs 2.2%; P 5 .001) grafts. The 1-year GRFS was 16% (95% confidence interval (CI): 8%-31%) vs 54% (95% CI: 44%-66%; P, .001) in the ATG and PTCy groups, respectively. The multivariable adjusted hazard ratio for GRFS was 0.34 (95% CI: 0.21-0.55; P, .001) with the use of PTCy. The 1-year overall survival in the ATG group was 45% (95% CI: 32%-62%) vs 75% (95% CI: 66%-85%) in the PTCy group (P, .001). Relapse incidence was similar. One-year nonrelapse mortality was greater after ATG-based prophylaxis: 38% (95% CI: 23%-52%) vs 16% (95 CI: 9%-25%), P, .001. In summary, PTCy-based prophylaxis resulted in superior GRFS and overall survival in recipients of MMUD. © 2022 by The American Society of Hematology. |
| Journal Title: | Blood Advances |
| Volume: | 6 |
| Issue: | 15 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2022-08-09 |
| Start Page: | 4491 |
| End Page: | 4500 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2022007596 |
| PUBMED: | 35793451 |
| PROVIDER: | scopus |
| PMCID: | PMC9636312 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 September 2022 -- Source: Scopus |
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