Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant.

Content Provider	Semantic Scholar
Author	Ruggeri, Annalisa Labopin, Myriam Bacigalupo, Andrea A. Lorentino, Francesca Arcese, William Santarone, Stella Gülbaş, Zafer Blaise, Didier Messina, Giuseppe Ghavamzadeh, A. Malard, Florent Bruno, Benedetto Díez-Martín, José Luís Koç, Yener Ciceri, Fabio Mohty, Mohamad Nagler, Arnon
Copyright Year	2017
Abstract	Severe graft-versus-host disease is a major barrier for non-T-cell-depleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received post-transplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95%CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95%CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95%CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulin-based group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95%CI: 0.98-2.09); P=0.06] for post-transplant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with non-relapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus-host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and non-relapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia.
Starting Page	401
Ending Page	410
Page Count	10
File Format	PDF HTM / HTML
DOI	10.3324/haematol.2016.151779
PubMed reference number	27758821
Journal	Medline
Volume Number	102
Issue Number	2
Alternate Webpage(s)	https://aperto.unito.it/retrieve/handle/2318/1609843/317198/1020401.pdf
Alternate Webpage(s)	http://www.haematologica.org/content/haematol/102/2/401.full.pdf
Journal	Haematologica
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article