Optimized GVHD Prevention in HLA-Mismatched Unrelated Allogeneic HCT Using a PTCY-Based Approach

• Type: Article in International Scientific Journal
• Date: 2024

Authors

Azevedo, NF (Author) FEUP; Suarez-Lledó, M (Author) Other; Guardia, L (Author) Other; Charry, P (Author) Other; Cid, J (Author) Other; Lozano, M (Author) Other; Pedraza, A (Author) Other; de Llobet, N (Author) Other; Corrius, G (Author) Other; Moreno, C (Author) Other; Esteve, J (Author) Other; Serra, C (Author) Other; Carreras, E (Author) Other; Rosiñol, L (Author) Other; Fernández-Avilés, F (Author) Other; Rovira, M (Author) Other; Martinez, C (Author) Other; Salas, MQ (Author) Other

Journal

Title: European Journal of Haematology

ISSN: 0902-4441

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-017-R95

DOI: 10.1111/ejh.14378

Abstract (EN): Although post-transplant cyclophosphamide (PTCY)-based prophylaxis has become a widely adopted strategy for preventing graft-versus-host disease (GVHD) in 9 out of 10 HLA-mismatched unrelated donors (MMUDs), allogeneic hematopoietic cell transplants (allo-HCTs), data on the safety and efficacy of PTCY in this setting remain limited. This single-center study investigates the outcomes of 94 adults with hematological malignancies undergoing MMUD allo-HCT with PTCY and tacrolimus (Tac) (PTCY-Tac) between 2014 and 2023. The median age was 53 years, and 60.6% were male. Peripheral blood stem cells were infused in all cases. By Day +100, the cumulative incidence of Grades II-IV and Grades III and IV acute GVHD were 33.0% and 9.7%, with 2-year incidence of moderate-to-severe chronic GVHD at 12.6%. By Day +30, 40.8% of patients experienced bacterial bloodstream infections, and 52.4% had cytomegalovirus (CMV) reactivation before letermovir prophylaxis. With letermovir's introduction, CMV reactivation rates dropped significantly, with only one case reported. At 3 years, overall survival was 60.8%, non-relapse mortality was 23%, and the cumulative incidence of relapse was 24.5%. HLA Class I or II mismatches did not affect key outcomes or GVHD rates. These findings demonstrate that PTCY-Tac offers effective GVHD prevention and favorable outcomes in MMUD allo-HCT, supporting its application for patients without fully matched donors.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 13