Comparison of Cyclophosphamide-Based Graft Versus Host Disease Prophylaxis after “Allogeneic Stem Cell Transplantation from 9/10HLA Matched Unrelated Donor’’ with Standard Graft Versus Host Disease Prophylaxis after “10/10HLA Matched Relative Donor’’

Murat Yıldırım, S. Sayın, Melda Cömert, Esra Safak Yilmaz, F. Avcu, A. Ural, M. Aylı
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Abstract

  Background: Graft Versus Host Disease (GvHD), which can be observed at a rate of 30-80% after allogeneic stem cell transplantation (ASCT) is an important complication that adversely affects the survival and quality of the life of patients. Posttransplant cyclophosphamide (PTCy) effectively prevents GvHD after HLA-haploidentical ASCT. In our study, the use of PTCy in 1-antigen HLA-mismatched unrelated donor (9/10MMUD) ASCT was compared with standard GvHD prophylaxis in HLA-identical related donor (MRD) ASCT. Materials and Methods: We conducted a retrospective study of the comparison of 42 patients with 9/10 MMUD ASCT receiving PTCy+Methotrexate (MTX)+Calcineurin Inhibitor (CNI) and 37 patients with HLA-identical MRD who received MTX+CNI  in 3 bone marrow transplantation centers.  Results: Cumulative incidences of grade I-II (64.6% vs 45.4%, p=0.187) or grade III to IV acute GvHD (35.4% vs54.6%, p=0.187) and chronic GvHD (11.9% vs 29.7%, p=0.096) were similar in the PTCy group and control group. No statistically significant differences were observed between PTCy and the control group in overall survival rate (52.4% vs 62.2%, p=0.381), progression-free survival (1483.97 vs 1200.70 days, p=0.502), relapsed-related mortality rate (21.4% vs 16.2%, p=0.556) and treatment-related mortality rate (16.7% vs 21.6%, p=0.575). Conclusion: With the addition of PTCy to standard GvHD prophylaxis in 9/10MMUD ASCT, the risk of GvHD due to incompatibility and unrelated transplantation is eliminated, and transplantation success is achieved with MRD ASCT. PTCy-based prophylaxis is an effective and safe strategy to prevent GvHD in 9/10 MMUD ASCT without increasing the risk of relapse and treatment-related mortality.
基于环磷酰胺的 "9/10HLA 匹配非亲缘供体异体干细胞移植 "后移植物抗宿主疾病预防疗法与 "10/10HLA 匹配亲缘供体 "后标准移植物抗宿主疾病预防疗法的比较
背景:同种异体干细胞移植(ASCT)后,移植物抗宿主疾病(GvHD)的发病率高达30%-80%,它是影响患者生存和生活质量的重要并发症。移植后环磷酰胺(PTCy)可有效预防HLA-同种异体干细胞移植后的GvHD。在我们的研究中,我们将在 1 抗原 HLA 不匹配的非亲属供者(9/10MMUD)ASCT 中使用 PTCy 与在 HLA 相同的亲属供者(MRD)ASCT 中使用标准 GvHD 预防措施进行了比较。材料与方法:我们进行了一项回顾性研究,比较了在 3 个骨髓移植中心接受 PTCy+ 甲氨蝶呤 (MTX)+ 钙嘌呤抑制剂 (CNI) 的 42 例 9/10 MMUD ASCT 患者和接受 MTX+CNI 的 37 例 HLA 相同的 MRD 患者。 研究结果PTCy组和对照组的I-II级(64.6% vs 45.4%,P=0.187)或III-IV级急性GvHD(35.4% vs 54.6%,P=0.187)和慢性GvHD(11.9% vs 29.7%,P=0.096)累积发生率相似。PTCy组与对照组在总生存率(52.4% vs 62.2%,P=0.381)、无进展生存期(1483.97 vs 1200.70天,P=0.502)、复发相关死亡率(21.4% vs 16.2%,P=0.556)和治疗相关死亡率(16.7% vs 21.6%,P=0.575)方面均无统计学差异。结论在9/10MMUD ASCT的标准GvHD预防中加入PTCy,可消除因不相容和非亲缘移植导致的GvHD风险,并通过MRD ASCT获得移植成功。在9/10MMUD ASCT中,以PTCy为基础的预防是预防GvHD的有效而安全的策略,同时不会增加复发风险和治疗相关死亡率。
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