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. 2024 Mar;204(3):959-966.
doi: 10.1111/bjh.19228. Epub 2023 Nov 30.

Low- versus standard-dose post-transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Shigeo Fuji  1 , Junichi Sugita  2 , Yuho Najima  3 , Tatsuya Konishi  4 , Takashi Tanaka  5 , Hiroyuki Ohigashi  6 , Tetsuya Eto  7 , Koji Nagafuji  8 , Nobuhiro Hiramoto  9 , Ken-Ichi Matsuoka  10 , Yumiko Maruyama  11 , Shuichi Ota  2 , Jun Ishikawa  1 , Toshiro Kawakita  12 , Takashi Akasaka  13 , Tomohiko Kamimura  14 , Masayuki Hino  15 , Takahiro Fukuda  5 , Yoshiko Atsuta  16   17 , Kimikazu Yakushijin  18
Affiliations

Low- versus standard-dose post-transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Shigeo Fuji et al. Br J Haematol. 2024 Mar.

Abstract

Haploidentical haematopoietic cell transplantation (haplo-HCT) using post-transplant cyclophosphamide (PTCY) as graft-versus-host disease (GVHD) prophylaxis is the standard of care for various haematological malignancies. The original PTCY dose after haplo-HCT was 100 mg/kg, but no dose-finding studies have been performed to identify the optimal dose. We performed a retrospective analysis to compare standard-dose PTCY (100 mg/kg) with reduced-dose PTCY (80 mg/kg): 969 in the standard-dose group and 538 in the reduced-dose group. As there was a significant difference between the two groups regarding patient and transplant characteristics, we performed propensity score (PS) matching. After PS matching, 425 patients in each group were included. The probabilities of 2-year OS were 55.9% in the standard-dose group and 47.0% in the reduced-dose group (p = 0.36). The cumulative incidences of 2-year non-relapse mortality were 21.3% in the standard-dose group and 20.5% in the reduced-dose group (p = 0.55). There was no significant difference in the incidence of acute (grade II-IV 29.2% [95% CI, 24.9-33.6] vs. 25.3% [95% CI, 21.3-29.6]; grade III-IV 7.3% [95% CI, 5.1-10.0] vs. 6.6% [95% CI, 4.5-9.3]) or chronic GVHD. In conclusion, reduced- and standard-dose PTCY were comparable in terms of major clinical outcomes.

Keywords: GVHD; haploidentical transplantation; post-transplant cyclophosphamide.

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Conflict of interest statement

The authors declare no conflicts of interest relevant to this manuscript.

References

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