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. 2024 Aug;103(8):3135-3143.
doi: 10.1007/s00277-024-05818-5. Epub 2024 May 29.

Reduced-toxicity conditioning regimen with low dose post-transplantation cyclophosphamide and low-dose anti-thymocyte globulin as graft-versus-host disease prophylaxis for haploidentical stem cell transplantation in older patients

Peipei Ye  1   2 , Mengjie Wu  1   2 , Junjie Cao  1   2 , Renzhi Pei  1   2 , Jiaojiao Yuan  1   2 , Haihui Zhuang  1   2 , Ying Fang  1   2 , Ying Lu  3   4
Affiliations

Reduced-toxicity conditioning regimen with low dose post-transplantation cyclophosphamide and low-dose anti-thymocyte globulin as graft-versus-host disease prophylaxis for haploidentical stem cell transplantation in older patients

Peipei Ye et al. Ann Hematol. 2024 Aug.

Abstract

Reduced-toxicity conditioning (RIC) regimens are used for allogeneic hematopoietic stem cell transplantation in older patients. However, successful outcomes are hindered by graft-versus-host disease (GVHD), treatment-related mortality, and relapse, particularly after haploidentical donor hematopoietic stem cell transplantation (HID-HSCT). The aim of this study was to evaluate the effectiveness of an RIC conditioning regimen that included a combination of cyclosporin A, methotrexate (on day + 1), mycophenolate, lower doses of post-transplantation PTCy (40 mg/kg on day + 3), and ATG (7.5 mg/kg) as GVHD prophylaxis prior to haplo-stem cell transplantation (haplo-SCT) in older patients.

Methods: We retrospectively analyzed outcomes in 55 patients ≥ 55 years of age with hematologic malignancies treated with fludarabine, cytarabine, busulfan, and low-dose cyclophosphamide as the conditioning regimen between January 1, 2019, and November 30, 2023.

Results: Neutrophil engraftment was successful in all patients within 28 days, with 54 patients (98.2%) achieving complete donor chimerism. The cumulative incidence of non-relapse mortality was 0% at 30 days, 7.5% at 100 days, and 19% at 1 year. The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was 25% (95%CI, 15-38%), whereas that of grade III-IV aGVHD was 9.1% (95% CI, 3.3-19%). The cumulative incidence of extensive chronic graft-versus-host disease at 1 year was 3.6% (95%CI, 0.66-11%). The cumulative incidences of relapse, overall survival, and GVHD-free/relapse-free survival at 1 year were 9.0%, 71.6%, and 67.1%, respectively.

Conclusions: An RIC conditioning regimen, including a combination of lower PTCy/ATG as GVHD prophylaxis, followed by haplo-SCT, might be a promising option for appropriately selected older patients.

Keywords: Anti-thymocyte globulin; Haploidentical stem cell transplantation; Older patients; Post-transplantation cyclophosphamide; Reduced-toxicity conditioning regimen.

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References

    1. Ustun C, Le-Rademacher J, Wang HL et al (2019) Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. Leukemia 33:2599–2609. https://doi.org/10.1038/s41375-019-0477-x - DOI - PubMed - PMC
    1. Kanapuru B, Singh H, Kwitkowski V, Blumenthal G, Farrell AT, Pazdur R (2020) Older adults in hematologic malignancy trials: representation, barriers to participation and strategies for addressing underrepresentation. Blood Rev 43:100670. https://doi.org/10.1016/j.blre.2020.100670 - DOI - PubMed
    1. Ciurea SO, Rodrigues M, Giralt S, de Lima M (2009) Aging, acute myelogenous leukemia, and allogeneic transplantation: do they belong in the same sentence? Clin Lymphoma Myeloma 9:289–297. https://doi.org/10.3816/CLM.2009.n.057 - DOI - PubMed
    1. Kasamon YL, Bolanos-Meade J, Prince GT et al (2015) Outcomes of nonmyeloablative HLA-Haploidentical blood or marrow transplantation with high-dose Post-transplantation Cyclophosphamide in older adults. J Clin Oncol 33:3152–3161. https://doi.org/10.1200/JCO.2014.60.4777 - DOI - PubMed - PMC
    1. Sun YQ, Han TT, Wang Y et al (2021) Haploidentical stem cell transplantation with a Novel Conditioning Regimen in older patients: a prospective single-arm phase 2 study. Front Oncol 11:639502. https://doi.org/10.3389/fonc.2021.639502 - DOI - PubMed - PMC

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