Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft-versus-host disease prophylaxis in haploidentical transplant

作者：Ruggeri, Annalisa^*; Sun, Yuqian; Labopin, Myriam; Bacigalupo, Andrea; Lorentino, Francesca; Arcese, William; Santarone, Stella; Gulbas, Zafer; Blaise, Didier; Messina, Giuseppe; Ghavamzadeh, Ardeshi; Malard, Florent; Bruno, Benedetto; Diez-Martin, Jose Luis; Koc, Yener; Ciceri, Fabio; Mohty, Mohamad; Nagler, Arnon

来源：Haematologica-The Hematology Journal, 2017, 102(2): 401-410.

DOI：10.3324/haematol.2016.151779

• STEM-CELL TRANSPLANTATION
• BONE-MARROW-TRANSPLANTATION
• RISK ACUTE-LEUKEMIA
• HEMATOLOGICAL MALIGNANCIES
• CORD BLOOD
• OUTCOMES
• DONORS
• THYMOGLOBULIN(R)
• MULTICENTER
• REMISSION

evere graft-versus-host disease is a major barrier for non-T-celldepleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received posttransplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95% CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95% CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95% CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulinbased group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95% CI: 0.98-2.09); P=0.06] for post-trans-plant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with nonrelapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus- host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and nonrelapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia.

• 出版日期2017-2
• 单位北京大学