High-Dose Cyclophosphamide and Tacrolimus as Graft-versus-Host Disease Prophylaxis for Matched and Mismatched Unrelated Donor Transplantation. 2021

Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain.

The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of single-locus mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is unclear. The use of high-dose post-transplant cyclophosphamide (PTCy) after haploidentical transplantation is effective at overcoming the negative impact of HLA disparity on survival. Limited information is available regarding the efficacy of this strategy in alloHSCT from MMUDs. Most of the published studies have used the triple immunosuppressant model of haploidentical transplant combining PTCy with calcineurin inhibitors and mycophenolate mofetil or methotrexate. In our study, we propose the use of a simpler GVHD prophylaxis protocol comprising PTCy in combination with tacrolimus for MMUD and matched unrelated donor (MUD) alloHSCT. We performed a retrospective analysis of 109 consecutive recipients of alloHSCT from unrelated donors (MMUD, n = 55; MUD, n = 54) in a single center. Graft source was primarily peripheral blood (98%). No differences were observed between the MMUD and MUD groups with respect to 100-day cumulative incidence of grade II to IV acute GVHD (aGVHD; 31% versus 32%, respectively, P = .9), grade III to IV aGVHD (9% versus 7%, P = .7), and moderate/severe chronic GVHD (cGVHD) at 2 years (18% versus 14%, P = .6). Both groups showed similar cumulative incidence of 1 year nonrelapse mortality (13% versus 9%; P = .5) and 3-year relapse rates (24% versus 25%, P = .7). Progression-free survival and overall survival at 3 years for MMUD and MUD were 56% and 57% (P = .9) and 64% and 65% (P = .6), respectively. The 3-year probability of survival free of moderate/severe cGVHD and relapse was 56% and 55%, respectively. GVHD prophylaxis with PTCy and tacrolimus achieves low rates of severe aGVHD and cGVHD, as well as good survival outcomes, in recipients of both MMUD and MUD peripheral blood alloHSCT. This strategy overcomes the negative impact of single-locus HLA disparity.

UI MeSH Term Description Entries
D009364 Neoplasm Recurrence, Local The local recurrence of a neoplasm following treatment. It arises from microscopic cells of the original neoplasm that have escaped therapeutic intervention and later become clinically visible at the original site. Local Neoplasm Recurrence,Local Neoplasm Recurrences,Locoregional Neoplasm Recurrence,Neoplasm Recurrence, Locoregional,Neoplasm Recurrences, Local,Recurrence, Local Neoplasm,Recurrence, Locoregional Neoplasm,Recurrences, Local Neoplasm,Locoregional Neoplasm Recurrences,Neoplasm Recurrences, Locoregional,Recurrences, Locoregional Neoplasm
D003520 Cyclophosphamide Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the LIVER to form the active aldophosphamide. It has been used in the treatment of LYMPHOMA and LEUKEMIA. Its side effect, ALOPECIA, has been used for defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. (+,-)-2-(bis(2-Chloroethyl)amino)tetrahydro-2H-1,3,2-oxazaphosphorine 2-Oxide Monohydrate,B-518,Cyclophosphamide Anhydrous,Cyclophosphamide Monohydrate,Cyclophosphamide, (R)-Isomer,Cyclophosphamide, (S)-Isomer,Cyclophosphane,Cytophosphan,Cytophosphane,Cytoxan,Endoxan,NSC-26271,Neosar,Procytox,Sendoxan,B 518,B518,NSC 26271,NSC26271
D006086 Graft vs Host Disease The clinical entity characterized by anorexia, diarrhea, loss of hair, leukopenia, thrombocytopenia, growth retardation, and eventual death brought about by the GRAFT VS HOST REACTION. Graft-Versus-Host Disease,Homologous Wasting Disease,Runt Disease,Graft-vs-Host Disease,Disease, Graft-Versus-Host,Disease, Graft-vs-Host,Disease, Homologous Wasting,Disease, Runt,Diseases, Graft-Versus-Host,Diseases, Graft-vs-Host,Graft Versus Host Disease,Graft-Versus-Host Diseases,Graft-vs-Host Diseases
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D016559 Tacrolimus A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. Anhydrous Tacrolimus,FK-506,FK506,FR-900506,Prograf,Prograft,Tacrolimus Anhydrous,Anhydrous, Tacrolimus,FK 506,FR 900506,FR900506,Tacrolimus, Anhydrous
D061349 Unrelated Donors Providers of tissues for transplant to non-related individuals. Donors, Unrelated,Donor, Unrelated,Unrelated Donor

Related Publications

Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
September 2003, Blood,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
October 2022, Transplantation and cellular therapy,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
May 2016, British journal of haematology,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
September 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
June 1999, Bone marrow transplantation,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
March 2024, Blood cancer journal,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
October 1992, Bone marrow transplantation,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
December 1996, Blood,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
June 2019, Annals of hematology,
Alexandra Pedraza, and Sofia Jorge, and María Suárez-Lledó, and Arturo Pereira, and Gonzalo Gutiérrez-García, and Francesc Fernández-Avilés, and Laura Rosiñol, and Noemí Llobet, and Teresa Solano, and Álvaro Urbano-Ispízua, and Montserrat Rovira, and Carmen Martínez
February 2022, Transplantation and cellular therapy,
Copied contents to your clipboard!