6533b854fe1ef96bd12ae191
RESEARCH PRODUCT
Ex vivo T-cell depletion vs post-transplant cyclophosphamide, sirolimus, and mycophenolate mofetil as graft-vs-host disease prophylaxis for allogeneic hematopoietic stem cell transplantation.
Aitana Balaguer-rosellóRafael HernaniPedro ChorãoInés GómezJuan MontoroJuan MontoroOlga SalameroAbdiel QuinteroPere BarbaLorenzo JiJosé Luis PiñanaJosé Luis PiñanaCarlos SolanoGuillermo SanzGuillermo OrtíJaime SanzJaime SanzPilar SolvesDavid ValcárcelManuel GuerreiroJuan Carlos Hernandez BoludaMiguel A. SanzMiguel A. SanzElisa RoldánLaura Foxsubject
Malemedicine.medical_treatmentT-LymphocytesCD34Graft vs Host DiseaseHematopoietic stem cell transplantationMycophenolateGastroenterologySeverity of Illness IndexLeukocyte Count0302 clinical medicineImmune ReconstitutionPostoperative ComplicationsRecurrenceGVHD prophylaxisAntineoplastic Combined Chemotherapy ProtocolsCumulative incidenceHematopoietic Stem Cell TransplantationT-cell depletionHematologyGeneral MedicineMiddle AgedPrognosisLeukemia Myeloid Acutesurgical procedures operativeTreatment OutcomeT-cell depletion030220 oncology & carcinogenesishematopoietic stem cell transplantationcardiovascular systemFemalemedicine.drugAdultmedicine.medical_specialtyCyclophosphamideAdolescentLymphocyte Depletion03 medical and health sciencesYoung AdultInternal medicinemedicineHumansTransplantation HomologousGVHD prophylaxis T-cell depletion hematopoietic stem cell transplantation post-transplantation cyclophosphamideCyclophosphamideAgedPostoperative CareSirolimuspost-transplantation cyclophosphamidebusiness.industryMycophenolic AcidSirolimusbusinessEx vivoBiomarkers030215 immunologydescription
Objective To compare the efficacy and safety of CD34+ selected ex vivo T-cell depletion (TCD) vs post-transplant cyclophosphamide, sirolimus, and mycophenolate mofetil (PTCy-Sir-MMF) as graft-vs-host disease (GVHD) prophylaxis. Methods We retrospectively included patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) with either TCD (n = 38) or PTCy-Sir-MMF (n = 91). Results Cumulative incidence of neutrophil and platelet recovery was 92% vs 99% (P = .06) and 89% vs 97% (P = .3) in TCD and PTCy-Sir-MMF, respectively. Cumulative incidences of aGHVD grade II-IV, III-IV, and moderate to severe cGVHD were 11% vs 19% (P = .2), 3% vs 2% (P = .9), and 3% vs 36% (P < .001) in TCD and PTCy-Sir-MMF, respectively. The 2-year non-relapse mortality, relapse, disease-free and overall survival were 25% vs 8% (P = .01), 20% vs 16% (P = .2), 55% vs 76% (P = .004), 57% vs 83% (P = .004) for TCD and PTCy-Sir-MMF, respectively. Cumulative incidence of cytomegalovirus and Epstein-Barr infection requiring therapy was 76% vs 40% (P < .001) and 32% vs 0% (P < .001) in TCD and PTCy-Sir-MMF, respectively. PTCy-Sir-MMF platform showed faster T-cell reconstitution. Conclusions PTCy-Sir-MMF provides better survival outcomes but is associated with higher risk of cGVHD compared to TCD.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-01 | European journal of haematologyREFERENCES |