Graft-Versus-Host Disease Prophylaxis with Post-Transplantation Cyclophosphamide versus Cyclosporine A and Methotrexate in Matched Sibling Donor Transplantation

Arnon Nagler, Myriam Labopin, Bhagirathbhai Dholaria*, Depei Wu, Goda Choi, Mahmoud Aljurf, Fabio Ciceri, Tobias Gedde-Dahl, Ellen Meijer, Riitta Niittyvuopio, Sergey Bondarenko, Jean Henri Bourhis, Jan J Cornelissen, Gerard Socié, Yener Koc, Jonathan Canaani, Bipin Savani, Gesine Bug, Alexandros Spyridonidis, Sebastian GiebelEolia Brissot, Ali Bazarbachi, Jordi Esteve, Mohamad Mohty

*Corresponding author for this work

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    Cyclosporine A (CSA) and methotrexate (MTX) is the standard graft-versus-host disease (GVHD) prophylaxis regimen for matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). Recently, post-transplantation cyclophosphamide (PTCy) has been shown to be effective in GVHD prevention. In this registry-based study, we compared outcomes of 118 patients treated with PTCy and 1202 patients with CSA/MTX who underwent MSD allo-HCT for acute myelogenous leukemia. In a matched-pair analysis, PTCy was associated with a higher incidence of relapse at 2 years compared with CSA/MTX (41.1% versus 21.3%; P =.039). The incidences of day +180 grade II-IV acute GVHD and 2-year chronic GVHD were comparable in the PTCy and CSA/MTX arms (25.2% versus 25.4% [P =.90] and 42.6% versus 42.6% [P =.84], respectively). Similarly, 2-year leukemia-free survival (LFS; 54.4% versus 74.32%; P =.052), overall survival (OS; 70.6% versus 79.7%; P =.15), and GVHD-free relapse-free survival (GRFS; 38.1% versus 52.5%; P =.49) were not statistically different in the 2 arms. Our data show that GVHD prophylaxis with PTCy is feasible, resulting in similar incidences of GVHD, GRFS, LFS, and OS as seen with conventional CSA/MTX in patients undergoing allo-HCT from an MSD. The higher rate of relapse observed with PTCy needs further evaluation in a prospective study.

    Original languageEnglish
    Pages (from-to)86.e1-86.e8
    Number of pages8
    JournalTransplantation and cellular therapy
    Issue number2
    Early online date29-Nov-2021
    Publication statusPublished - Feb-2022

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