Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 May 6;13(1):46.
doi: 10.1186/s13045-020-00882-6.

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

Jaime Sanz  1   2 , Jacques-Emmanuel Galimard  3 , Myriam Labopin  3   4 , Boris Afanasyev  5 , Emanuele Angelucci  6 , Fabio Ciceri  7 , Didier Blaise  8 , Jan J Cornelissen  9 , Ellen Meijer  10 , J L Diez-Martin  11 , Yener Koc  12 , Montserrat Rovira  13   14 , Luca Castagna  15 , Bipin Savani  16 , Annalisa Ruggeri  17 , Arnon Nagler  18   19 , Mohamad Mohty  4 ; Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)
Affiliations
Comparative Study

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

Jaime Sanz et al. J Hematol Oncol. .

Abstract

Background: The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy.

Methods: We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017.

Results: The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9).

Conclusions: The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.

Keywords: Acute leukemia; Allogeneic stem cell transplant; Alternative donor transplants; Haploidentical transplant; Post-transplant cyclophosphamide.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of relapse according to the type of transplant
Fig. 2
Fig. 2
Cumulative incidence of non-relapse mortality according to the type of transplant
Fig. 3
Fig. 3
Probability of leukemia-free survival according to the type of transplant
Fig. 4
Fig. 4
Probability of overall survival according to the type of transplant
See this image and copyright information in PMC

References

    1. Luznik L, O’Donnell PV, Symons HJ, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Tr. 2008;14(6):641–650. doi: 10.1016/j.bbmt.2008.03.005. - DOI - PMC - PubMed
    1. Kasamon YL, Luznik L, Leffell MS, et al. Nonmyeloablative HLA-haploidentical bone marrow transplantation with high-dose posttransplantation cyclophosphamide: effect of HLA disparity on outcome. Biol Blood Marrow Tr. 2010;16(4):482–489. doi: 10.1016/j.bbmt.2009.11.011. - DOI - PMC - PubMed
    1. Raiola AM, Dominietto A, Ghiso A, et al. Unmanipulated haploidentical bone marrow transplantation and posttransplantation cyclophosphamide for hematologic malignancies after myeloablative conditioning. Biol Blood Marrow Tr. 2013;19(1):117–122. doi: 10.1016/j.bbmt.2012.08.014. - DOI - PubMed
    1. Luznik L, Bolaños-Meade J, Zahurak M, et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood. 2010;115(16):3224–3230. doi: 10.1182/blood-2009-11-251595. - DOI - PMC - PubMed
    1. Kanakry CG, O’Donnell PV, Furlong T, et al. Multi-institutional study of post-transplantation cyclophosphamide as single-agent graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation using myeloablative busulfan and fludarabine conditioning. J Clin Oncol. 2014;32(31):3497–3505. doi: 10.1200/JCO.2013.54.0625. - DOI - PMC - PubMed

Publication types