Graft versus host disease in unmanipulated haploidentical marrow transplantation with a modified post-transplant cyclophosphamide (PT-CY) regimen: an update on 425 patients

Research output: Contribution to journalArticle

Abstract

This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II–IV was 29%, and the CI of GvHD-grade III–IV was 4%. We found older donors and older patients to have higher rates of grade II–IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III–IV acute GvHD, on overall survival. The CI of moderate–severe chronic GvHD was 18%: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.

Original languageEnglish
Pages (from-to)708-712
Number of pages5
JournalBone Marrow Transplantation
Volume54
DOIs
Publication statusPublished - Aug 1 2019

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Graft vs Host Disease
Cyclophosphamide
Transplantation
Bone Marrow
Transplants
Tissue Donors
Thiotepa
Busulfan
Whole-Body Irradiation
Hematologic Neoplasms
Survival
Incidence

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

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title = "Graft versus host disease in unmanipulated haploidentical marrow transplantation with a modified post-transplant cyclophosphamide (PT-CY) regimen: an update on 425 patients",
abstract = "This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II–IV was 29{\%}, and the CI of GvHD-grade III–IV was 4{\%}. We found older donors and older patients to have higher rates of grade II–IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III–IV acute GvHD, on overall survival. The CI of moderate–severe chronic GvHD was 18{\%}: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.",
author = "Andrea Bacigalupo and {Maria Raiola}, Anna and Alida Dominietto and {Di Grazia}, Carmen and Francesca Gualandi and Lint, {Maria Teresa Van} and Patrizia Chiusolo and Luca Laurenti and Federica Sora and Sabrina Giammarco and Emanuele Angelucci",
year = "2019",
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day = "1",
doi = "10.1038/s41409-019-0594-1",
language = "English",
volume = "54",
pages = "708--712",
journal = "Bone Marrow Transplantation",
issn = "0268-3369",
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T1 - Graft versus host disease in unmanipulated haploidentical marrow transplantation with a modified post-transplant cyclophosphamide (PT-CY) regimen

T2 - an update on 425 patients

AU - Bacigalupo, Andrea

AU - Maria Raiola, Anna

AU - Dominietto, Alida

AU - Di Grazia, Carmen

AU - Gualandi, Francesca

AU - Lint, Maria Teresa Van

AU - Chiusolo, Patrizia

AU - Laurenti, Luca

AU - Sora, Federica

AU - Giammarco, Sabrina

AU - Angelucci, Emanuele

PY - 2019/8/1

Y1 - 2019/8/1

N2 - This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II–IV was 29%, and the CI of GvHD-grade III–IV was 4%. We found older donors and older patients to have higher rates of grade II–IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III–IV acute GvHD, on overall survival. The CI of moderate–severe chronic GvHD was 18%: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.

AB - This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II–IV was 29%, and the CI of GvHD-grade III–IV was 4%. We found older donors and older patients to have higher rates of grade II–IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III–IV acute GvHD, on overall survival. The CI of moderate–severe chronic GvHD was 18%: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.

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