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Post-transplant cyclophosphamide demonstrates lower non-relapse mortality and better graft-versus-host disease/relapse-free survival compared with antithymocyte globulin in unrelated donor hematopoietic stem cell transplantation. A single-center experience

Bone Marrow Transplantation volume 56, pages 986–988 (2021)Cite this article

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Graft-vs.-host disease (GVHD) remains the most relevant complication following allogeneic hematopoietic stem cell transplantation (HSCT) [1]. Unrelated donor (UD) transplant is associated with a higher incidence of GVHD, due to major and minor Human Leukocyte Antigen (HLA) disparities [2].

Antithymocyte globulin (ATG), plus a calcineurin inhibitor and methotrexate, has been the standard of care for GVHD prophylaxis in the setting of UD transplantation [3]. Nevertheless, it can be associated with an increased risk in early opportunistic infections, in particular cytomegalovirus (CMV) reactivation [4] and considerable long-term relapse rate [5]. Since the Baltimore experience, post-transplant cyclophosphamide (PTCy) was adopted as a GVHD prophylaxis platform worldwide for haploidentical transplant [6] and has been recently used in other donor settings [7].

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Fig. 1: Long termn survival outcomes comparing PTCy vs. ATG.

References

  1. Zeiser R, Blazar B. Acute graft-versus-host disease—biologic process, prevention and therapy. N. Engl J Med. 2017;377:2167–79.

    Article  CAS  Google Scholar 

  2. Martin P, Levine D, Storer B, Warren E, Zheng X, Nelson C, et al. Genome-wide minor histocompatibility matching as related to the risk of graft-versus-host disease. Blood 2017;129:791–8.

    Article  CAS  Google Scholar 

  3. Ruutu T, Gratwohl A, de Witte T, Afanasyev B, Apperley J, Bacigalupo A, et al. Prophylaxis and treatment of GVHD; EBMT-ELN working group recommendations for standardized practice. Bone Marrow Transpl. 2014;49:168–73.

    Article  CAS  Google Scholar 

  4. Einsel H, Ljungman P, Boeckh M. How I treat CMV reactivation after allogeneic hematopoietic stem cell transplantation. Blood. 2020;135:1619–29.

    Article  Google Scholar 

  5. Baron F, Mohty M, Blaise D, Socie G, Labopin M, Esteve J, et al. Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the acute leukemia working party of the European Society for Blood and Marrow Transplantation. Haematologica 2017;102:224–34.

    Article  CAS  Google Scholar 

  6. Ciurea S, Zhang M, Bacigalupo A, Bashey A, Appelbaum F, Aljitawi O, et al. Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia. Blood 2015;126:1033–40.

    Article  CAS  Google Scholar 

  7. Kanakry C, O’Donnell P, Furlong T, de Lima M, Wei W, Medeot M, et al. Multi-institutional study of post-transplantation cyclophosphamide as single-agent graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation using myeloablative busulfan and fludarabine conditioning. J Clin Oncol. 2014;32:3497–505.

    Article  CAS  Google Scholar 

  8. Sanz J, Galimard J, Labopin M, Afanasyev B, Angelucci E, Ciceri F, et al. Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT. J Hematol Oncol. 2020;13. https://doi.org/10.1186/s13045-020-00882-6.

  9. Ruggeri A, Labopin M, Bacigalupo A, Afanasyev B, Cornalissen J, Elmaagacli A, et al. Post-transplant cyclophosphamide for graft-versus-host disease prophylaxis in HLA matched sibling or matched unrelated donor transplant for patients with acute leukemia, on behalf of ALWP-EBMT. J Hematol Oncol. 2018;11:40.

    Article  Google Scholar 

  10. Battipaglia G, Labopin M, Kroger N, Vitek A, Afanasyev B, Hilgendorf I, et al. Posttransplant cyclophosphamide vs antithymocyte globulin in HLA/mismatched unrelated donor transplantation. Blood 2019;134:892–9.

    Article  CAS  Google Scholar 

  11. Nykolyszyn C, Granata A, Pagliardini T, Castagna L, Harbi S, Boubdallah R, et al. Posttransplantation cyclophosphamide vs. antithymocyte globulin as GVHD prophylaxis for mismathched unrelated hematopoietic stem cell transplantation. Bone Marrow Transpl. 2020;55:349–55.

    Article  CAS  Google Scholar 

  12. Moiseev I, Pirogova O, Alyanski A, Babenko E, Gindina T, Darskaya E, et al. Graft-versus-host disease prophylaxis in unrelated peripheral blood stem cell transplantation with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Biol Blood Marrow Transpl. 2016;22:1037–42.

    Article  CAS  Google Scholar 

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  1. Servicio de Hematología, Unidad de Trasplante Hematopoyético, Hospital Universitario Austral, Pilar, Argentina

    M. Berro, M. Rivas, J. Trucco, I. Paganini, I. Ravchina & G. Kusminsky

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  1. M. Berro
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  2. M. Rivas
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Correspondence to M. Berro.

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Berro, M., Rivas, M., Trucco, J. et al. Post-transplant cyclophosphamide demonstrates lower non-relapse mortality and better graft-versus-host disease/relapse-free survival compared with antithymocyte globulin in unrelated donor hematopoietic stem cell transplantation. A single-center experience. Bone Marrow Transplant 56, 986–988 (2021). https://doi.org/10.1038/s41409-020-01146-0

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