Posttransplant cyclophosphamide in HLA-matched and 1-2 allele mismatched peripheral blood stem cell transplantation

Author:

Teshima Takanori1ORCID,Sugita Junichi2ORCID,Kuroha Takashi3,Ishikawa Jun4,Eto Tetsuya5,Fukushima Kentaro6,Yokota Isao7ORCID,Akashi Koichi8,Harada Mine9,Taniguchi Shuichi5

Affiliation:

1. Hokkaido University Faculty of Medicine

2. Hokkaido University Graduate School of Medicine

3. Nagaoka Red Cross Hospital

4. Osaka International Cancer Institute

5. Hamanomachi Hospital

6. Osaka University Graduate School of Medicine

7. Hokkaido Univiersity

8. Kyushu University

9. Karatsu Higashimatsuura Medical Association

Abstract

Abstract Posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis has been increasingly used in HLA-haploidentical transplantation and recent studies also demonstrated the efficacy of PTCy in HLA-matched transplantation. However, data on PTCy in HLA 1–2 allele mismatched transplants are limited. We conducted a prospective multicenter phase II study to evaluate the safety and efficacy of PTCy with tacrolimus and mycophenolate mofetil in 43 patients who underwent HLA-matched (n = 21) or HLA 1–2 allele mismatched (n = 22) peripheral blood stem cell transplantation (PBSCT) following myeloablative (n = 28) or reduced-intensity (n = 15) conditioning. The incidence of grade III-IV acute GVHD at 100 days was 2.3%. The incidences of grades II-IV acute GVHD, all grade chronic GVHD, and moderate to severe chronic GVHD at 2 years were 16.3%, 14.0%, and 4.7%, respectively. Overall survival, disease-free survival, and non-relapse mortality at 2 years were 75.3%, 74.0%, and 7.0%, respectively. GVHD-free, relapse-free survival at 2 years was 67.0%. The rate of off-immunosuppressants in patients who survived without relapse at 2 years was 85.4%. These results indicate that PTCy is a valid option for GVHD prophylaxis in both HLA-matched and HLA 1–2 allele mismatched PBSCT.

Publisher

Research Square Platform LLC

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