PTCY and Tacrolimus for GVHD prevention for older adults undergoing HLA-matched sibling and unrelated donor alloHCT
Salas, María Queralt (Hospital Clínic i Provincial de Barcelona)
Charry, Paola (Hospital Clínic i Provincial de Barcelona)
Pedraza, Alexandra (Hospital Clínic i Provincial de Barcelona)
Martínez-Cibrian, N.uria (Hospital Clínic i Provincial de Barcelona)
Solano, Maria Teresa (Hospital Clínic i Provincial de Barcelona)
Domènech, Ariadna (Hospital Clínic i Provincial de Barcelona)
Suárez-Lledó, Maria (Universitat de Barcelona)
Nomdedeu, Meritxell (Universitat de Barcelona)
Cid, Joan (Universitat de Barcelona)
Lozano, Miquel (Universitat de Barcelona)
de-LLobet, Noemi (Hospital Clínic i Provincial de Barcelona)
Arcarons, Jordi (Hospital Clínic i Provincial de Barcelona)
Rosiñol, Laura (Universitat de Barcelona)
Gutiérrez-García, Gonzalo (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Carreras, Enric (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Esteve Reyner, Jordi (Universitat de Barcelona)
Urbano Ispizua, Álvaro (Universitat de Barcelona)
Fernandez Aviles, Francesc (Universitat de Barcelona)
Rovira, Montserrat (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)
Martínez, Carmen (Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras)

Fecha:	2022
Resumen:	The use of post-transplantation cyclophosphamide (PTCY) for graft-versus-host disease (GHVD) prevention is becoming prevalent in the transplantation community when HLA-identical sibling and 10/10 HLA-matched (MUD) and 9/10 mismatched unrelated donors are selected for alloHSCT. However, reported evidence on outcomes from elderly patients receiving PTCY-containing GVHD prophylaxis remains limited. This study aims to compare the outcomes of PTCY- tacrolimus (TK) prophylaxis and conventional GVHD prophylaxis in patients aged >50 years undergoing peripheral blood alloHSCT from a single institution. A total of 161 consecutive patients aged >50 years undergoing alloHSCT between January 2014 and February 2021 were included. Data were collected retrospectively and updated in December 2021. Patients received grafts from HLA-identical sibling, and from 10/10 and 9/10 HLA matched and mismatched unrelated donors. Overall, median age was 60 years, and 91 (54. 8%) received PTCY-TK for GVHD prevention. Time to neutrophil and platelet engraftment was longer in the PTCY-TK group (20 versus 16 days and 19 versus 11 days, P <. 001). The cumulative incidences of grade II-IV and III-IV acute GVHD (aGVHD) at day 100 and moderate/severe chronic GVHD (cGVHD) at 2 years were 18. 2%, 5. 7%, and 9. 5% for patients receiving PTCY-TK, and 26. 0%, 9. 6% and 39. 5% for those who did not. The multivariate analysis showed that PTCY-TK reduced the probability of grade II-IV aGVHD (hazard ratio [HR] 0. 41, P =. 035), of cGVHD (any grade: HR 0. 43 [P =. 014], and of moderate/severe cGVHD [HR 0. 15 {P <. 001}]). At 2 years, the overall survival (65. 4% versus 65. 6%, P =. 472), non-relapse mortality (17. 4% versus 13. 7%, P =. 967), and cumulative incidence of relapse rates (24. 2% versus 27. 5%, P =. 712) were comparable between both cohorts; GVHD-free/relapse-free survival (GRFS) was higher in the PTCY-TK group (2 years: 50. 2% versus 21. 8%; HR 0. 42, P =. 001). In patients aged ≥50 years. PTCY-TK was safe and a more effective drug combination than non-PTCY containing GVHD prophylaxis, even with the use of matched and mismatched unrelated donors, and resulted in comparable relapse rates and better GRFS.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Allogeneic hematopoietic stem cell transplantation ; Post-transplant cyclophosphamide ; Adults ; Older adults ; GVHD ; GRFS
Publicado en:	Transplantation and cellular therapy, Vol. 28 Núm. 8 (august 2022) , p. 489.e1-489.e9, ISSN 2666-6367

DOI: 10.1016/j.jtct.2022.05.009

9 p, 739.7 KB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP) > Instituto de Investigación contra la Leucemia Josep Carreras
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