Posttransplant cyclophosphamide as GVHD prophylaxis for peripheral blood stem cell HLA-mismatched unrelated donor transplant

Malki, Monzr M. Al; Tsai, Ni‐Chun; Palmer, Joycelynne; Mokhtari, Sally; Tsai, Wei-Feng; Cao, Thai M.; Ali, Haris; Salhotra, Amandeep; Arslan, Shukaib; Aldoss, Ibrahim; Karras, Nicole; Karanes, Chatchada; Zain, Jasmine; Khaled, Samer K.; Stein, Anthony S.; Snyder, David S.; Marcucci, Guido; Forman, Stephen J.; Nakamura, Ryotaro

doi:10.1182/bloodadvances.2021004192

Cited by 48 publications

(33 citation statements)

References 46 publications

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“…A total of 3336 patients from 19 studies were included in this systematic review and meta-analysis, with a median age of 52.1 (6-76.5) years (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), and 53% (n=1659/3116) of recipients were male (20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Eighty-six percent (n=1055/1222) patients were Caucasian and 5.8% (n=71/1222) were African American (30-16).…”

Section: Resultsmentioning

confidence: 99%

“…Eighty-six percent (n=1055/1222) patients were Caucasian and 5.8% (n=71/1222) were African American (30-16). The primary graft source was bone marrow (BM) in 19% (n=646/3336) and peripheral blood stem cells (PBSC) in 81% (n=2690/3336) of the recipients (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The median time to transplant was 10 (1-247) months (15,20,(22)(23)(24)28) and median follow-up time was 33 (0.4-135.6) months (16, 20-22, 24-32, 34-37).…”

Section: Resultsmentioning

confidence: 99%

“…The primary graft source was bone marrow (BM) in 19% (n=646/3336) and peripheral blood stem cells (PBSC) in 81% (n=2690/3336) of the recipients (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The median time to transplant was 10 (1-247) months (15,20,(22)(23)(24)28) and median follow-up time was 33 (0.4-135.6) months (16, 20-22, 24-32, 34-37). Reduced-intensity conditioning (RIC) conditioning was used for 65.6% (n=2191) of the patients while 32% (n=1066) of patients received myeloablative conditioning (MAC).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies, including 3169 patients, did not use PT-Cy for GVHD prophylaxis. The median age was 51.7 (6-76.5) years (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and 56.5% (n=1614/2859) recipients were male (20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32). The graft source was BM in 17% (n=546/3169) and PBSC in 82% (n=2623/3169) of the recipients (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: Outcomes After Mmud Hsct Without Post-transplant Cyclophosph...mentioning

confidence: 99%

“…The median age was 51.7 (6-76.5) years (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and 56.5% (n=1614/2859) recipients were male (20)(21)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32). The graft source was BM in 17% (n=546/3169) and PBSC in 82% (n=2623/3169) of the recipients (16,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The median time to transplant from hematologic diagnosis was 10 (1-247) months (20, 22-24, 28, 30), and median follow-up time was 35.1 (0.4-135.6) months (16,(20)(21)(22)(23)(24)(25)(26)(27)<...…”

Section: Outcomes After Mmud Hsct Without Post-transplant Cyclophosph...mentioning

confidence: 99%

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Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis

Mushtaq

Shahzad²,

Tariq³

et al. 2022

Front. Oncol.

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BackgroundAllogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for various hematologic disorders. Alternative donor strategies such as mismatched unrelated donors (MMUD) offer the option of HSCT to patients lacking a human leukocyte antigen (HLA)-matched donor. We conducted a systematic review and meta-analysis to evaluate outcomes after MMUD-HSCT.MethodsA literature search was performed on PubMed, Cochrane Library, and ClinicalTrials.gov from the inception date through April 6, 2022. After screening 2477 manuscripts, 19 studies were included. Data was extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pooled analysis was done using the meta-package by Schwarzer et al. Proportions with 95% confidence intervals (CI) were computed.ResultsA total of 3336 patients from 19 studies were included. The median age was 52.1 years, and 53% of recipients were males. The graft source was bone marrow in 19% and peripheral blood stem cells in 81% of recipients. The median time to transplant from hematologic diagnosis was 10 (1-247) months. Hematologic diagnoses included myeloid (82.9%), lymphoid (41.1%), and other disorders (3%). The reduced intensity and myeloablative conditioning were used in 65.6% and 32% of recipients, respectively. In-vivo T-cell depletion was performed in 56.7% of the patients. Most patients had one (87.9%) or two (11.4%) antigen HLA-mismatch. The pooled 1-year overall survival (OS) was 63.9% (95% CI 0.57-0.71, n=1426/2706), and the pooled 3-year OS was 42.1% (95% CI 0.34.2-0.50, n=907/2355). The pooled progression-free survival was 46.6% (95% CI 0.39-0.55, n=1295/3253) after a median follow-up of 1.8 (range 1-6) years. The pooled relapse rate was 26.8% (95% CI 0.22-0.32, n=972/3253) after a median follow-up of 2.25 (1-3) years. The pooled incidence of acute (grade II-IV) graft-versus-host disease (GVHD) and chronic GVHD was 36.4% (95% CI 0.31-0.42, n=1131/3030) and 41.2% (95% CI 0.35-0.48, n=1337/3228), respectively. The pooled non-relapse mortality was 22.6% (95% CI 0.17-0.29, n=888/3196) after a median follow-up of 2.6 (1-5) years.ConclusionMMUD-HSCT has demonstrated favorable outcomes with an acceptable toxicity profile. It represents a promising option in patients lacking an HLA-matched or haploidentical donor and may expand HSCT access to underrepresented racial and ethnic populations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Outcomes After Mmud Hsct Without Post-transplant Cyclophosph...mentioning

confidence: 99%

Section: Outcomes After Mmud Hsct Without Post-transplant Cyclophosph...mentioning

confidence: 99%

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Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis

Mushtaq

Shahzad²,

Tariq³

et al. 2022

Front. Oncol.

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Mismatched donor allogeneic hematopoietic cell transplantation with post‐transplant cyclophosphamide achieves comparable outcomes between racially and ethnically diverse patient populations

Caprice,

Fan,

Kim

et al. 2024

American J Hematol

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Comparable relapse incidence after unrelated allogeneic stem cell transplantation with post‐transplant cyclophosphamide versus conventional anti‐graft versus host disease prophylaxis in patients with acute myeloid leukemia: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Nagler,

Ngoya,

Galimard

et al. 2024

American J Hematol

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We compared relapse incidence (RI) post‐unrelated transplantation with post‐transplant cyclophosphamide (PTCy) versus no PTCy graft‐versus‐host disease (GVHD) prophylaxis, in 7049 acute myeloid leukemia (AML) patients in remission, 707 with PTCy, and 6342 without (No PTCy). The patients in the PTCy group were younger, 52.7 versus 56.6 years (p < .001). There were more 9/10 donors in the PTCy group, 33.8% versus 16.4% (p < .001), and more received myeloablative conditioning, 61.7% versus 50.2% (p < .001). In the No PTCy group, 87.7% of patients received in vivo T‐cell depletion. Neutrophil and platelet engraftment were lower in the PTCy versus No PTCy group, 93.8% and 80.9% versus 97.6% and 92.6% (p < .001). RI was not significantly different in the PTCy versus the No PTCy group, hazard ratio (HR) of 1.11 (95% confidence interval [CI] 0.9–1.37) (p = .31). Acute GVHD grades II–IV and III–IV, were significantly lower in the PTCy versus the No PTCy group, HR of 0.74 (95% CI 0.59–0.92, p = .007) and HR = 0.56 (95% CI 0.38–0.83, p = .004), as were total and extensive chronic GVHD, HRs of 0.5 (95% CI 0.41–0.62, p < .001) and HR = 0.31 (95% CI 0.22–0.42, p < .001). Non‐relapse mortality (NRM) was significantly lower with PTCy versus the No PTCy group, HR of 0.67 (95% CI 0.5–0.91, p = .007). GVHD‐free, relapse‐free survival (GRFS) was higher in the PTCy versus the No PTCy group, HR of 0.69 (95% CI 0.59–0.81, p = .001). Leukemia‐free survival (LFS) and overall survival (OS) did not differ between the groups. In summary, we observed comparable RI, OS, and LFS, significantly lower incidences of GVHD and NRM, and significantly higher GRFS in AML patients undergoing unrelated donor‐hematopoietic stem cell transplantation with PTCy versus No PTCy GVHD prophylaxis.

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Posttransplant cyclophosphamide as GVHD prophylaxis for peripheral blood stem cell HLA-mismatched unrelated donor transplant

Cited by 48 publications

References 46 publications

Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis

Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis

Mismatched donor allogeneic hematopoietic cell transplantation with post‐transplant cyclophosphamide achieves comparable outcomes between racially and ethnically diverse patient populations

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