Characteristics of graft-versus-host disease (GvHD) after post-transplantation cyclophosphamide versus conventional GvHD prophylaxis Journal Article
| Authors: | Saliba, R. M.; Alousi, A. M.; Pidala, J.; Arora, M.; Spellman, S. R.; Hemmer, M. T.; Wang, T.; Abboud, C.; Ahmed, S.; Antin, J. H.; Beitinjaneh, A.; Buchbinder, D.; Byrne, M.; Cahn, J. Y.; Choe, H.; Hanna, R.; Hematti, P.; Kamble, R. T.; Kitko, C. L.; Laughlin, M.; Lekakis, L.; MacMillan, M. L.; Martino, R.; Mehta, P. A.; Nishihori, T.; Patel, S. S.; Perales, M. A.; Rangarajan, H. G.; Ringdén, O.; Rosenthal, J.; Savani, B. N.; Schultz, K. R.; Seo, S.; Teshima, T.; van der Poel, M.; Verdonck, L. F.; Weisdorf, D.; Wirk, B.; Yared, J. A.; Schriber, J.; Champlin, R. E.; Ciurea, S. O. |
| Article Title: | Characteristics of graft-versus-host disease (GvHD) after post-transplantation cyclophosphamide versus conventional GvHD prophylaxis |
| Abstract: | Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] =. 4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR =. 6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR =. 6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR =. 9, P =. 6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate. © 2022 The American Society for Transplantation and Cellular Therapy |
| Keywords: | adult; controlled study; human tissue; retrospective studies; major clinical study; overall survival; mortality; cohort analysis; relapse; cyclophosphamide; hematopoietic stem cell transplantation; retrospective study; acute graft versus host disease; chronic graft versus host disease; disease severity; prophylaxis; graft versus host reaction; hla typing; graft vs host disease; thymocyte antibody; lymphocyte antibody; adverse event; clinical outcome; graft-versus-host disease; mortality rate; antilymphocyte serum; humans; human; male; female; article; organ distribution; haploidentical transplantation; post-transplantation cyclophosphamide; non-relapse mortality; matched unrelated donor; disease risk assessment |
| Journal Title: | Transplantation and Cellular Therapy |
| Volume: | 28 |
| Issue: | 10 |
| ISSN: | 2666-6375 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-10-01 |
| Start Page: | 681 |
| End Page: | 693 |
| Language: | English |
| DOI: | 10.1016/j.jtct.2022.07.013 |
| PUBMED: | 35853610 |
| PROVIDER: | scopus |
| PMCID: | PMC10141544 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 November 2022 -- Source: Scopus |
