Reduced post-transplant cyclophosphamide dose with antithymocyte globulin in peripheral blood stem cell haploidentical transplantation.
Rémy DuléryFlorent MalardEolia BrissotAnne BanetSimona SestiliRamdane BelhocineMartina CalabroZoé Van de WyngaertAgnès BonninTounes LedraaOllivier LegrandMyriam LabopinElodie CapderouAriel CohenStéphane EderhyFlorent MalardPublished in: Bone marrow transplantation (2023)
Post-transplant cyclophosphamide (PT-Cy) is effective for graft-versus-host disease (GVHD) prophylaxis, but it may cause dose-dependent toxicities, particularly in frail patients. Therefore, we compared the outcomes with a reduced PT-Cy total dose (70 mg/kg) to those with the standard PT-Cy dose (100 mg/kg) in haploidentical hematopoietic cell transplantation (HCT) patients aged ≥ 65 years and those with cardiac comorbidities. All consecutive patients with a hematological malignancy receiving peripheral blood stem cells (PBSCs) after a thiotepa-based conditioning with low-dose antithymocyte globulin were included. Thirty-three patients received PT-Cy at 70 mg/kg and 25 at 100 mg/kg. PT-Cy dose reduction did not increase the risk of GVHD and was associated with faster neutrophil and platelet recovery, and lower cumulative incidences of bacteremia (38% versus 72%, p = 0.004) and cardiac complications (12% versus 44%, p = 0.028). At 2 years, GVHD-free, relapse-free survival (GRFS) was higher with the reduced dose compared to the standard dose (60% versus 33%, p = 0.04). In conclusion, reducing PT-Cy total dose to 70 mg/kg is a safe and valid approach for elderly patients and those with cardiac comorbidities underdoing haploidentical HCT with PBSCs and low-dose antithymocyte globulin. The reduced PT-Cy dose was associated with improved hematological count recovery, lower incidence of toxicities, and higher GRFS.
Keyphrases
- peripheral blood
- low dose
- stem cells
- end stage renal disease
- newly diagnosed
- ejection fraction
- high dose
- chronic kidney disease
- free survival
- stem cell transplantation
- risk factors
- prognostic factors
- left ventricular
- bone marrow
- peritoneal dialysis
- type diabetes
- heart failure
- mesenchymal stem cells
- adipose tissue
- allogeneic hematopoietic stem cell transplantation
- patient reported outcomes
- acute lymphoblastic leukemia
- signaling pathway
- cell therapy
- cell death
- patient reported
- skeletal muscle
- pi k akt
- glycemic control