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

Annalisa Ruggeri, Y Sun, M Labopin, A Bacigalupo, F Lorentino, William Arcese, S Santarone, Z Gülbas, D Blaise, G Messina, A Ghavamzadeh, F Malard, Benedetto Bruno, JL Diez-Martin, Y Koc, F Ciceri, M Mohty, A Nagler

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Abstract

Severe graft-versus-host disease is a major barrier for non-T-celldepleted 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 posttransplant 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 globulinbased 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-trans- plant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with nonrelapse 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 nonrelapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia. © 2017 Ferrata Storti Foundation.
Original languageEnglish
Pages (from-to)401-410
Number of pages10
JournalHaematologica
Volume102
Issue number2
DOIs
Publication statusPublished - 2017

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Antilymphocyte Serum
Graft vs Host Disease
Cyclophosphamide
Transplants
Survival
Recurrence
Acute Myeloid Leukemia
Mortality
Leukemia
Multivariate Analysis
Incidence
Stem Cell Transplantation
Thymocytes
Bone Marrow Transplantation
Bone Marrow

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Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. / Ruggeri, Annalisa; Sun, Y; Labopin, M; Bacigalupo, A; Lorentino, F; Arcese, William; Santarone, S; Gülbas, Z; Blaise, D; Messina, G; Ghavamzadeh, A; Malard, F; Bruno, Benedetto; Diez-Martin, JL; Koc, Y; Ciceri, F; Mohty, M; Nagler, A.

In: Haematologica, Vol. 102, No. 2, 2017, p. 401-410.

Research output: Contribution to journalArticle

Ruggeri, A, Sun, Y, Labopin, M, Bacigalupo, A, Lorentino, F, Arcese, W, Santarone, S, Gülbas, Z, Blaise, D, Messina, G, Ghavamzadeh, A, Malard, F, Bruno, B, Diez-Martin, JL, Koc, Y, Ciceri, F, Mohty, M & Nagler, A 2017, 'Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant', Haematologica, vol. 102, no. 2, pp. 401-410. https://doi.org/10.3324/haematol.2016.151779
Ruggeri, Annalisa ; Sun, Y ; Labopin, M ; Bacigalupo, A ; Lorentino, F ; Arcese, William ; Santarone, S ; Gülbas, Z ; Blaise, D ; Messina, G ; Ghavamzadeh, A ; Malard, F ; Bruno, Benedetto ; Diez-Martin, JL ; Koc, Y ; Ciceri, F ; Mohty, M ; Nagler, A. / Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. In: Haematologica. 2017 ; Vol. 102, No. 2. pp. 401-410.
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AU - Ruggeri, Annalisa

AU - Sun, Y

AU - Labopin, M

AU - Bacigalupo, A

AU - Lorentino, F

AU - Arcese, William

AU - Santarone, S

AU - Gülbas, Z

AU - Blaise, D

AU - Messina, G

AU - Ghavamzadeh, A

AU - Malard, F

AU - Bruno, Benedetto

AU - Diez-Martin, JL

AU - Koc, Y

AU - Ciceri, F

AU - Mohty, M

AU - Nagler, A

PY - 2017

Y1 - 2017

N2 - Severe graft-versus-host disease is a major barrier for non-T-celldepleted 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 posttransplant 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 globulinbased 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-trans- plant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with nonrelapse 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 nonrelapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia. © 2017 Ferrata Storti Foundation.

AB - Severe graft-versus-host disease is a major barrier for non-T-celldepleted 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 posttransplant 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 globulinbased 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-trans- plant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with nonrelapse 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 nonrelapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia. © 2017 Ferrata Storti Foundation.

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DO - 10.3324/haematol.2016.151779

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JO - Haematologica

JF - Haematologica

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