Comparison of Post-transplant Cyclophosphamide Containing Immunosuppressive Regimen with Standard Immunosuppressive Regimen in Allogeneic Stem Cell Transplantation from Matched Sibling Donor

Abstract

Address for Correspondence: Tayfun ELİBOL MD, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Clinic of Hematology, İstanbul, Turkey Phone: +90 539 656 29 42 E-mail: tayfunelibol@gmail.com ORCID ID: orcid.org/0000-0001-8738-5246 Received: 09.05.2021 Accepted: 05.08.2021 ÖZ Amaç: Allojenik kök hücre nakli (AKHN), birçok hematolojik malignite için, graft-versus-host hastalığı (GVHH) gibi bazı hayatı tehdit edici risklerine rağmen halen tek küratif tedavi yöntemidir. GVHH post-transplant siklofosfamid uygulamasıyla birlikte haploidentik kök hücre nakli yapılan hastalarda dahi kontrol altına alınabilmektedir. Çalışmamızın amacı da tam uyumlu kardeş donörden yapılan nakillerde post-transplant siklofosfamid kullanımının GVHH üzerine olan etkinliğini standart immünosüpresif tedaviyle karşılaştırmaktır. Gereç ve Yöntem: Yüksek riskli hematolojik malignite tanısı olup tam uyumlu kardeş donörden AKHN yapılan hastalar çalışmaya alındı. Posttransplant siklofosfamid tedavisi alan hastalar, immünosüpresif tedavi olarak ayrıca takrolimus ve mikofenolat mofetil aldı; diğer kolda ise hastalar metotreksat ve siklosporin ile standart immünosüpresif tedavi aldı. Çalışmanın primer sonlanım noktası şiddetli akut GVHH gelişimi sıklığı olarak belirlendi. ABSTRACT Aim: Allogeneic stem cell transplantation (ASCT) is the only treatment that can cure most of malignant hematological diseases with the risk of some serious complications such as graft-versus-host disease (GVHD). GVHD can be got under control with post-transplant cyclophosphamide even in patients with haploidentical stem cell transplants. Here, we aimed to compare the effectiveness of post-transplant cyclophosphamide on GVHD with standard immunosuppressive therapy. Materials and Methods: Patients with high-risk hematologic malignancies, who received ASCT from human leukocyte antigen-matched sibling donors, were studied. Patients in the post-transplant cyclophosphamide group also used tacrolimus and mycophenolate mofetil; on the other side, standard immunosuppressive treatment with cyclosporine and methotrexate was used. The primary endpoint of the study was to compare the severe acute GVHD rate between the groups. Results: A total of 40 patients were included in the study. While severe (grade 3-4) GVHD was seen in three patients in the methotrexate-cyclosporin group, it was not seen in any patient in the post-transplant cyclophosphamide group. Also, 10th-month progress-free survival and overall survivals were 78.8% and 93.3% vs 56% and 72% in the post-transplant cyclophosphamide group and methotrexate-cyclosporin group, respectively. Conclusion: Cyclophosphamide can be the cheapest, most applicable, and clinically effective treatment in GVHD prophylaxis.