TY - JOUR
T1 - Comparable relapse incidence after unrelated allogeneic stem cell transplantation with post-transplant cyclophosphamide versus conventional anti-graft versus host disease prophylaxis in patients with acute myeloid leukemia
T2 - A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
AU - Nagler, Arnon
AU - Ngoya, Maud
AU - Galimard, Jacques-Emmanuel
AU - Labopin, Myriam
AU - Blau, Igor Wolfgang
AU - Kröger, Nicolaus
AU - Gedde-Dahl, Tobias
AU - Schroeder, Thomas
AU - Burns, David
AU - Salmenniemi, Urpu
AU - Rambaldi, Alessandro
AU - Choi, Goda
AU - Peffault de Latour, Régis
AU - Vydra, Jan
AU - Sengeloev, Henrik
AU - Eder, Matthias
AU - Mielke, Stephan
AU - Forcade, Edouard
AU - Kulagin, Alexander
AU - Ciceri, Fabio
AU - Mohty, Mohamad
N1 - © 2024 Wiley Periodicals LLC.
PY - 2024
Y1 - 2024
N2 - We compared relapse incidence (RI) post-unrelated transplantation with post-transplant cyclophosphamide (PTCy) versus no PTCy graft-versus-host disease (GVHD) prophylaxis, in 7049 acute myeloid leukemia (AML) patients in remission, 707 with PTCy, and 6342 without (No PTCy). The patients in the PTCy group were younger, 52.7 versus 56.6 years (p < .001). There were more 9/10 donors in the PTCy group, 33.8% versus 16.4% (p < .001), and more received myeloablative conditioning, 61.7% versus 50.2% (p < .001). In the No PTCy group, 87.7% of patients received in vivo T-cell depletion. Neutrophil and platelet engraftment were lower in the PTCy versus No PTCy group, 93.8% and 80.9% versus 97.6% and 92.6% (p < .001). RI was not significantly different in the PTCy versus the No PTCy group, hazard ratio (HR) of 1.11 (95% confidence interval [CI] 0.9-1.37) (p = .31). Acute GVHD grades II-IV and III-IV, were significantly lower in the PTCy versus the No PTCy group, HR of 0.74 (95% CI 0.59-0.92, p = .007) and HR = 0.56 (95% CI 0.38-0.83, p = .004), as were total and extensive chronic GVHD, HRs of 0.5 (95% CI 0.41-0.62, p < .001) and HR = 0.31 (95% CI 0.22-0.42, p < .001). Non-relapse mortality (NRM) was significantly lower with PTCy versus the No PTCy group, HR of 0.67 (95% CI 0.5-0.91, p = .007). GVHD-free, relapse-free survival (GRFS) was higher in the PTCy versus the No PTCy group, HR of 0.69 (95% CI 0.59-0.81, p = .001). Leukemia-free survival (LFS) and overall survival (OS) did not differ between the groups. In summary, we observed comparable RI, OS, and LFS, significantly lower incidences of GVHD and NRM, and significantly higher GRFS in AML patients undergoing unrelated donor-hematopoietic stem cell transplantation with PTCy versus No PTCy GVHD prophylaxis.
AB - We compared relapse incidence (RI) post-unrelated transplantation with post-transplant cyclophosphamide (PTCy) versus no PTCy graft-versus-host disease (GVHD) prophylaxis, in 7049 acute myeloid leukemia (AML) patients in remission, 707 with PTCy, and 6342 without (No PTCy). The patients in the PTCy group were younger, 52.7 versus 56.6 years (p < .001). There were more 9/10 donors in the PTCy group, 33.8% versus 16.4% (p < .001), and more received myeloablative conditioning, 61.7% versus 50.2% (p < .001). In the No PTCy group, 87.7% of patients received in vivo T-cell depletion. Neutrophil and platelet engraftment were lower in the PTCy versus No PTCy group, 93.8% and 80.9% versus 97.6% and 92.6% (p < .001). RI was not significantly different in the PTCy versus the No PTCy group, hazard ratio (HR) of 1.11 (95% confidence interval [CI] 0.9-1.37) (p = .31). Acute GVHD grades II-IV and III-IV, were significantly lower in the PTCy versus the No PTCy group, HR of 0.74 (95% CI 0.59-0.92, p = .007) and HR = 0.56 (95% CI 0.38-0.83, p = .004), as were total and extensive chronic GVHD, HRs of 0.5 (95% CI 0.41-0.62, p < .001) and HR = 0.31 (95% CI 0.22-0.42, p < .001). Non-relapse mortality (NRM) was significantly lower with PTCy versus the No PTCy group, HR of 0.67 (95% CI 0.5-0.91, p = .007). GVHD-free, relapse-free survival (GRFS) was higher in the PTCy versus the No PTCy group, HR of 0.69 (95% CI 0.59-0.81, p = .001). Leukemia-free survival (LFS) and overall survival (OS) did not differ between the groups. In summary, we observed comparable RI, OS, and LFS, significantly lower incidences of GVHD and NRM, and significantly higher GRFS in AML patients undergoing unrelated donor-hematopoietic stem cell transplantation with PTCy versus No PTCy GVHD prophylaxis.
KW - Adolescent
KW - Adult
KW - Aged
KW - Cyclophosphamide/therapeutic use
KW - Female
KW - Graft vs Host Disease/prevention & control
KW - Hematopoietic Stem Cell Transplantation/methods
KW - Humans
KW - Immunosuppressive Agents/therapeutic use
KW - Incidence
KW - Leukemia, Myeloid, Acute/therapy
KW - Male
KW - Middle Aged
KW - Recurrence
KW - Retrospective Studies
KW - Transplantation Conditioning/methods
KW - Transplantation, Homologous
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85195569025&partnerID=8YFLogxK
U2 - 10.1002/ajh.27383
DO - 10.1002/ajh.27383
M3 - Journal article
C2 - 38856236
SN - 0361-8609
VL - 99
SP - 1732
EP - 1745
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 9
ER -