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Triple post transplant cyclophosphamide (PTCY) based GVHD prophylaxis: HLA matched versus HLA haploidentical transplants

Bone Marrow Transplantation volume 57, pages 532–537 (2022)Cite this article

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Abstract

We report a retrospective analysis of 198 allogeneic hematopoietic stem cell transplant (HSCT) recipients with post-transplant cyclophosphamide (PTCY), cyclosporine and mycophenolate mophetil as graft-versus-host-disease (GVHD) prophylaxis: the donors were HLA-matched (n = 78), or haploidentical relatives (HAPLO) (n = 120). The two groups were comparable except for older age in the HAPLO group. The main diagnosis were acute leukemia (57%) and myelofibrosis (21%). In the HLA-matched and HAPLO group the outcomes were as follows: aGVHD grade II-IV, 10% vs 27% (p = 0.005); moderate-severe cGVHD, 4% vs 19% (p = 0.004); transplant related mortality (TRM) at 1 year 10% vs 21% (p = 0.04); relapse at 1 year 24% vs 10% (p = 0.051) respectively. Disease free survival (DFS) at 1 year was 65% for matched and 68% for HAPLOs (p = 0.85). DFS and OS were independently predicted by age over 60 and higher DRI, whether the only independent predictive variable for GVHD and relapse free survival (GRFS) was age over 60. In conclusion: given the same PTCY based, GVHD prophylaxis, HLA-mismatched grafts are exposed to a higher risk of acute and chronic GVHD. This translates in increased TRM. DFS is comparable for HLA matched and HAPLO grafts.

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Fig. 1: Grade II-IV Acute GVHD and moderate-to-severe chronic GVHD are shown for HLA matched (continuous line) and HLA haploidentical transplants (dashed line).
Fig. 2: Disease free survival (DFS), Transplant Related Mortality (TRM) and Relapses are shown for HLA matched (in red) and for HLA haploidentical (in blue) transplants.
Fig. 3

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Acknowledgements

This study was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) grant to AB. Authors declare no competing interests.

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  1. Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy

    Eugenio Galli, Luca Laurenti, Federica Sorà, Patrizia Chiusolo, Luciana Teofili, Andrea Bacigalupo & Simona Sica

  2. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy

    Eugenio Galli, Elisabetta Metafuni, Sabrina Giammarco, Maria Assunta Limongiello, Idanna Innocenti, Francesco Autore, Luca Laurenti, Federica Sorà, Patrizia Chiusolo, Andrea Bacigalupo & Simona Sica

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  1. Eugenio Galli
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EG SS, and AB designed the study and drafted the paper. EM SG PC FS FA and MAL provided clinical data. LL II and LT critically reviewed the paper.

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Correspondence to Eugenio Galli.

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Galli, E., Metafuni, E., Giammarco, S. et al. Triple post transplant cyclophosphamide (PTCY) based GVHD prophylaxis: HLA matched versus HLA haploidentical transplants. Bone Marrow Transplant 57, 532–537 (2022). https://doi.org/10.1038/s41409-022-01574-0

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