Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey.
Clin Transplant. 2024 Jun;38(6):e15376. doi: 10.1111/ctr.15376.
Cyclosporine-A (CsA) and post transplantation cyclophosphamide (PTCy) are common agents used for graft versus host disease (GVHD) prophylaxis in Haploidentical hematopoietic cell transplantation (haplo-HCT). However, the impact of CsA cessation timing in the posttransplant setting on clinical outcomes is uncertain. We aimed to investigate the impact of a novel approach that integrated early CsA cessation with PTCy utilization.
This study was a single arm retrospective study carried out at a tertiary referral hospital hematology and bone marrow transplantation center between 2009 and 2022. The patients who received haplo-HCT with ATG, PTCy and CsA as GVHD prophylaxis were included. CsA was planned for cessation starting at day 45 to day 60. Acute and chronic GVHD were evaluated and graded. CsA blood concentrations and its impact on acute and chronic GVHD was evaluated.
Thirty-one patients composed of 19 (61.3%) male and 12 (38.7%) female patients with a median age of 31 years (20-58). Busulfan and TBI based conditioning regimens were the most utilized regimens. The majority of donors were first degree relatives. Stem cell origin was peripheral blood for all patients. GVHD prophylaxis consisted of ATG, CsA and PTCy. Acute GVHD was observed in 9 (29%) cases, whereas chronic GVHD was seen in 3 (9.7%) cases, with 2 of them having overlapping GVHD. Age, gender, number of chemotherapy lines, transplant characteristics, infused CD34 cell count, and engraftment durations were similar among patients with and without GVHD. Patients with GVHD had similar 1st, 2nd, 3rd and 4th week CsA concentrations compared to patients without GVHD (p > 0.05). The presence of GVHD was not associated with worse progression free survival and overall survival (p = 0.6, p = 0.5, respectively). CMV reactivation was more common in the GVHD group.
In the current study, we did not find an impact of CsA concentration on GVHD and post-transplant outcomes in Haplo-HCT setting. Therefore, together with the use of PTCy, early CsA cessation can be an option; further studies are needed to understand all aspects of this approach.
环孢素 A（CsA）和移植后环磷酰胺（PTCy）是异基因造血细胞移植（haplo-HCT）中用于预防移植物抗宿主病（GVHD）的常用药物。然而，在移植后环境中 CsA 停药时间对临床结果的影响尚不确定。我们旨在研究一种新方法的影响，该方法将早期 CsA 停药与 PTCy 的使用相结合。
这是一项在 2009 年至 2022 年在三级转诊医院血液学和骨髓移植中心进行的单臂回顾性研究。包括接受 ATG、PTCy 和 CsA 作为 GVHD 预防的 haplo-HCT 的患者。计划在第 45 至 60 天开始停止 CsA。评估和分级急性和慢性 GVHD。评估 CsA 血药浓度及其对急性和慢性 GVHD 的影响。
31 名患者包括 19 名（61.3%）男性和 12 名（38.7%）女性，中位年龄为 31 岁（20-58 岁）。以白消安和 TBI 为基础的预处理方案是最常用的方案。大多数供者是一级亲属。所有患者的干细胞来源均为外周血。GVHD 预防包括 ATG、CsA 和 PTCy。9 例（29%）发生急性 GVHD，3 例（9.7%）发生慢性 GVHD，其中 2 例重叠 GVHD。GVHD 患者与无 GVHD 患者的年龄、性别、化疗线数、移植特征、输注的 CD34 细胞计数和植入持续时间相似。有 GVHD 的患者与无 GVHD 的患者在第 1、2、3 和 4 周的 CsA 浓度相似（p>0.05）。GVHD 的存在与无 GVHD 的患者相比，与无进展生存期和总生存期无差异（p=0.6，p=0.5）。CMV 再激活在 GVHD 组更为常见。
在目前的研究中，我们没有发现 CsA 浓度对 haplo-HCT 环境中 GVHD 和移植后结果有影响。因此，与使用 PTCy 一起，早期 CsA 停药可以作为一种选择；需要进一步研究来了解这种方法的各个方面。
