A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia

A Multicenter Study

Patrizia Chiusolo, Gesine Bug, Attilio Olivieri, Mats Brune, Nicola Mordini, Paolo Emilio Alessandrino, Alida Dominietto, Anna Maria Raiola, Carmen Di Grazia, Francesca Gualandi, Maria Teresa Van Lint, Felicetto Ferrara, Olimpia Finizio, Emanuele Angelucci, Andrea Bacigalupo

Research output: Contribution to journalArticle

Abstract

We report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17-74) years, 51 (34%) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92%, 17%, and 15%, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20% and 24%, respectively. Four-year survival for remission patients was 72% (74% versus 67% for <60 or ≥60 years of age) and 26% for advanced patients (17% versus 41% for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age.

Original languageEnglish
Pages (from-to)1243-1249
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number6
DOIs
Publication statusPublished - Jun 2018

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Acute Myeloid Leukemia
Cyclophosphamide
Multicenter Studies
Transplantation
Bone Marrow
Transplants
Graft vs Host Disease
Recurrence
Cyclosporine
Incidence
Survival
Mortality
Multivariate Analysis

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A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia : A Multicenter Study. / Chiusolo, Patrizia; Bug, Gesine; Olivieri, Attilio; Brune, Mats; Mordini, Nicola; Alessandrino, Paolo Emilio; Dominietto, Alida; Raiola, Anna Maria; Di Grazia, Carmen; Gualandi, Francesca; Van Lint, Maria Teresa; Ferrara, Felicetto; Finizio, Olimpia; Angelucci, Emanuele; Bacigalupo, Andrea.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 6, 06.2018, p. 1243-1249.

Research output: Contribution to journalArticle

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title = "A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia: A Multicenter Study",
abstract = "We report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17-74) years, 51 (34{\%}) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92{\%}, 17{\%}, and 15{\%}, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20{\%} and 24{\%}, respectively. Four-year survival for remission patients was 72{\%} (74{\%} versus 67{\%} for <60 or ≥60 years of age) and 26{\%} for advanced patients (17{\%} versus 41{\%} for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age.",
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T1 - A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia

T2 - A Multicenter Study

AU - Chiusolo, Patrizia

AU - Bug, Gesine

AU - Olivieri, Attilio

AU - Brune, Mats

AU - Mordini, Nicola

AU - Alessandrino, Paolo Emilio

AU - Dominietto, Alida

AU - Raiola, Anna Maria

AU - Di Grazia, Carmen

AU - Gualandi, Francesca

AU - Van Lint, Maria Teresa

AU - Ferrara, Felicetto

AU - Finizio, Olimpia

AU - Angelucci, Emanuele

AU - Bacigalupo, Andrea

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018/6

Y1 - 2018/6

N2 - We report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17-74) years, 51 (34%) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92%, 17%, and 15%, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20% and 24%, respectively. Four-year survival for remission patients was 72% (74% versus 67% for <60 or ≥60 years of age) and 26% for advanced patients (17% versus 41% for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age.

AB - We report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17-74) years, 51 (34%) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92%, 17%, and 15%, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20% and 24%, respectively. Four-year survival for remission patients was 72% (74% versus 67% for <60 or ≥60 years of age) and 26% for advanced patients (17% versus 41% for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age.

U2 - 10.1016/j.bbmt.2018.01.031

DO - 10.1016/j.bbmt.2018.01.031

M3 - Article

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SP - 1243

EP - 1249

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

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ER -