Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Transplant Cell Ther. 2022 Oct;28(10):681-693. doi: 10.1016/j.jtct.2022.07.013. Epub 2022 Jul 16.
Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.
移植后环磷酰胺（PTCy）已被证明可有效控制单倍体（Haplo）移植后移植物抗宿主病（GvHD）。在这项回顾性注册研究中，我们比较了接受 Haplo 移植后接受 PTCy GvHD 预防（Haplo/PTCy）与接受 HLA 匹配无关供体移植后接受常规预防（MUD/常规）的患者的 GvHD 器官分布、严重程度和结局。我们评估了两个队列：264 例和 1163 例 Haplo 和 MUD 移植患者发生 2 至 4 级急性 GvHD（aGvHD）；以及 206 例和 1018 例 Haplo 和 MUD 移植患者发生任何慢性 GvHD（cGvHD）。与 MUD/常规移植±抗胸腺细胞球蛋白（ATG）相比，Haplo/PTCy 移植后 3-4 级 aGvHD（28%对 39%，P=0.001）、3-4 级下胃肠道（GI）aGvHD（14%对 21%，P=0.01）和慢性 GI GvHD（21%对 31%，P=0.006）较少见。在发生 2-4 级 aGvHD 的患者中，与非清髓性预处理条件下未使用 ATG 的 MUD/常规移植相比，Haplo/PTCY 后 cGvHD 率也较低（风险比[HR]=0.4，P<0.001）。无论是否使用 ATG，Haplo/PTCy 移植后非复发死亡率也较低（HR=0.6，P=0.01），但女性供体移植给男性受者除外。在发生 cGvHD 的患者中，无论是否使用 ATG，Haplo/PTCy 移植后非复发死亡率较低（HR=0.6，P=0.04）。cGvHD 诊断后 6 个月内（HR=1.6，P=0.03）死亡率较高，但 6 个月后（HR=0.9，P=0.6）死亡率较低。
