Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Department of Hematology, Harasanshin Hospital, Fukuoka, Japan.
Bone Marrow Transplant. 2021 Mar;56(3):596-604. doi: 10.1038/s41409-020-01065-0. Epub 2020 Sep 24.
Posttransplant cyclophosphamide (PTCy:100 mg/kg) has been increasingly used in allogeneic hematopoietic stem cell transplantation, however, few studies compared different doses of PTCy. We conducted two consecutive prospective multicenter phase II studies to evaluate the safety and efficacy of 80 mg/kg of PTCy in 137 patients who underwent HLA-haploidentical peripheral blood stem cell transplantation (haploPBSCT) following reduced-intensity conditioning (RIC). GVHD prophylaxis consisted of PTCy at a dose of 40 mg/kg/day on days 3 and 4, tacrolimus, and mycophenolate mofetil. Neutrophil engraftment was achieved in 97% and 96% in the first and second studies, respectively. The incidences of grades II-IV acute GVHD, III-IV acute GVHD, all grade chronic GVHD, and moderate to severe chronic GVHD at 2 years were 26%, 5%, 35%, and 18% in the first study, and 23%, 1%, 28%, and 15% in the second study, respectively. Overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) at 2 years were 51%, 42%, and 18% in the first study, and 58%, 48%, and 16% in the second study, respectively. The rates of off-immunosuppressants in patients who survived without relapse at 2 years were 83 and 76%. Our results suggest that 80 mg/kg of PTCy is a valid option in haploPBSCT following RIC.
移植后环磷酰胺(PTCy:100mg/kg)已越来越多地用于异基因造血干细胞移植,但很少有研究比较不同剂量的 PTCy。我们进行了两项连续的前瞻性多中心 II 期研究,以评估 137 例接受 HLA 单倍体外周血造血干细胞移植(haploPBSCT)后接受低强度预处理(RIC)的患者中 80mg/kg PTCy 的安全性和有效性。GVHD 预防包括在第 3 天和第 4 天给予 40mg/kg/天的 PTCy、他克莫司和吗替麦考酚酯。在第一和第二研究中,中性粒细胞植入分别达到 97%和 96%。第一研究中,2 年时 II-IV 级急性 GVHD、III-IV 级急性 GVHD、所有级别慢性 GVHD 和中重度慢性 GVHD 的发生率分别为 26%、5%、35%和 18%,第二研究中分别为 23%、1%、28%和 15%。第一研究中,2 年时的总生存率(OS)、无病生存率(DFS)和非复发死亡率(NRM)分别为 51%、42%和 18%,第二研究中分别为 58%、48%和 16%。在无复发且存活 2 年的患者中,停用免疫抑制剂的比例分别为 83%和 76%。我们的研究结果表明,在 RIC 后进行 haploPBSCT 时,80mg/kg 的 PTCy 是一种有效的选择。