Post-Transplantation Cyclophosphamide and Tacrolimus for Graft-versus-Host Disease Prevention after Allogeneic Hematopoietic Cell Transplantation from HLA-Matched Donors Has More Advantages Than Limitations
Salas, María Queralt (Hospital Clínic i Provincial de Barcelona)
Pedraza, Alexandra (Hospital Clínic i Provincial de Barcelona)
Charry, Paola (Hospital Clínic i Provincial de Barcelona)
Suárez-Lledó Grande, María (Hospital Clínic i Provincial de Barcelona)
Rodríguez Lobato, Luis Gerardo (Hospital Clínic i Provincial de Barcelona)
Brusosa, M. (Universitat de Barcelona)
Solano, María Teresa (Hospital Clínic i Provincial de Barcelona)
Serrahima, Anna (Hospital Clínic i Provincial de Barcelona)
Nomdedeu, Meritxell (Universitat de Barcelona)
Cid, Joan (Hospital Clínic i Provincial de Barcelona)
Lozano, Miquel (Hospital Clínic i Provincial de Barcelona)
Arcarons, Jordi (Hospital Clínic i Provincial de Barcelona)
de Llobet, Noemí (Hospital Clínic i Provincial de Barcelona)
Rosiñol, Laura (Hospital Clínic i Provincial de Barcelona)
Esteve Reyner, Jordi (Hospital Clínic i Provincial de Barcelona)
Urbano Ispizua, Álvaro (Hospital Clínic i Provincial de Barcelona)
Carreras, E. (Fundació Josep Carreras Contra la Leucèmia)
Fernandez Aviles, Francesc (Hospital Clínic i Provincial de Barcelona)
Rovira, Montserrat (Hospital Clínic i Provincial de Barcelona)
Martínez, Carmen (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	This study compared the efficacy of graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) and tacrolimus (Tac) versus other regimens in 272 adults undergoing peripheral blood (PB) allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched donors. Of these 272 patients, 95 (34. 9%) received PTCy/Tac. The times to neutrophil and platelet engraftment were longer in the PTCy/Tac group (20 days versus 16 days for neutrophils and 19 days versus 12 days for platelets). The day +30 cumulative incidence (CuI) of bacterial bloodstream infection was higher in the PTCy/Tac group (43. 2% versus 13. 0%; P <. 001). The CuIs of grade II-IV and grade III-IV acute GVHD (aGVHD) at day +180 were 14. 7% and 4. 2%, and the CuI of moderate/severe cGVHD at 2 years was 2. 4% in the PTCy/Tac group and 41. 8% (hazard ratio [HR],. 29; P <. 001), 15. 8%, (HR,. 24; P =. 007), and 47. 0% (HR,. 05; P <. 001), respectively, in the no-PTCy group. The duration of immunosuppression was shorter in patients receiving PTCy/Tac (6. 2 months versus 9. 0 months; P <. 001). PTCy/Tac patients had higher OS (2 years: 74. 3% versus 60. 9%; HR,. 54; P =. 012), lower NRM (2 years: 8. 6% versus 15. 8%; HR,. 54; P =. 11), comparable CuI of relapse (2 years: 26. 0% versus 24. 4%; HR, 1. 03; P =. 89), and higher GRFS (2 years: 59. 1% versus 16. 7%; HR,. 32; P <. 001). Using PTCy/Tac in HLA-matched PB allo-HCT improved transplantation outcomes at out institution compared with previous prophylactic regimens, including a higher probability of survival despite more delayed engraftment and a higher rate of bacterial infection.
Drets:	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.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Allogeneic stem cell transplantation ; Matched related donor ; Matched unrelated donor ; PTCy/Tac ; Peripheral blood stem cell grafts ; Post-transplantation cyclophosphamide ; Tacrolimus
Publicat a:	Transplantation and cellular therapy, Vol. 30 Núm. 2 (february 2024) , p. 213.e1-213.e12, ISSN 2666-6367

DOI: 10.1016/j.jtct.2023.11.020
PMID: 38042256

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