Incidence, risk factors and therapy response of acute graft-versus-host disease after myeloablative hematopoietic stem cell transplantation with posttransplant cyclophosphamide

被引：2

作者：

Canto, P. Asensi ^{[1
]}

Gomez-Segui, I. ^{[1
,2
]}

Montoro, J. ^{[1
,3
]}

Montaner, M. Villalba ^{[1
]}

Chorao, P. ^{[1
]}

Alcaina, P. Solves ^{[1
,2
]}

Balsera, M. Santiago ^{[1
]}

Madrid, P. Lloret ^{[1
]}

Ruiz, J. Solis ^{[4
]}

Pell-Ilderton, C. Sopena ^{[1
]}

Campuzano, D. Martinez ^{[1
]}

Serrano, P. Granados ^{[1
]}

del Rio, J. Eiris ^{[1
]}

Louro, A. ^{[1
]}

Rebollar, P. ^{[1
]}

Perla, A. ^{[1
]}

Benavente, R. ^{[5
]}

Comos, J. De la Rubia ^{[1
,2
,3
]}

Sanz, M. A. ^{[1
,6
]}

Balaguer, A. ^{[1
]}

Sanz, J. ^{[1
,6
]}

机构：

[1] Hosp Univ & Politecn La Fe, Hematol Dept, Valencia, Spain

[2] Inst Carlos III, CIBERONC, Madrid, Spain

[3] Catholic Univ Valencia, Sch Med & Dent, Valencia, Spain

[4] Transfus Ctr, Valencia, Spain

[5] Univ Chile, Internal Med Dept, Santiago, Chile

[6] Univ Valencia, Dept Med, Valencia, Spain

来源：

BONE MARROW TRANSPLANTATION | 2024年 / 59卷 / 11期

关键词：

BONE-MARROW-TRANSPLANTATION; HEMATOLOGIC MALIGNANCIES; GVHD PROPHYLAXIS; INITIAL THERAPY; BLOOD; CYCLOSPORINE; SIROLIMUS; SURVIVAL; DONORS; METHOTREXATE;

D O I：

10.1038/s41409-024-02391-3

中图分类号：

Q6 [生物物理学];

学科分类号：

071011 ;

摘要：

Posttransplant cyclophosphamide, sirolimus and mycophenolate mofetil (PTCy/siro/MMF) constitutes an innovative and well-tolerated acute graft-versus-host disease (aGVHD) prophylaxis after allogeneic stem cell transplantation (allo-HSCT), but risk factors for aGVHD incidence and therapy failure in this setting are scarce. This study prospectively registered all consecutive adult patients with hematologic malignancies who received a myeloablative allo-HSCT using PTCy/siro/MMF prophylaxis at our institution between 2017 and 2023. A total of 385 patients were included, of whom 44%, 34% and 22% were transplanted from matched sibiling, matched unrelated and haploidentical donors, respectively. The 180-day cumulative incidence of aGVHD was 21% (95% confidence interval [CI] 17-25%) for grade II-IV and 11% (95% CI 8-14%) grade III-IV aGVHD. The use of haploidentical donors was associated with an increased risk of severe aGVHD. Among 75 patients receiving first-line systemic corticosteroids, 49% achieved a sustained complete response, while 23% and 24% developed steroid-dependent (SD-aGVHD) and steroid-refractory aGVHD (SR-aGVHD), respectively. SR-aGVHD was associated with worse salvage treatment response and overall survival compared to SD-aGVHD. The 1-year cumulative incidence of aGVHD-related mortality was 5.4% (95% CI, 3.3-8.1). Risk factors for aGVHD-related mortality included haploidentical donors, older donors, diagnosis of myeldysplastic neoplasms, and grade IV aGVHD. This study confirms a low incidence aGVHD with PTCy/siro/MMF prophylaxis. SR-aGVHD showed poorer response to salvage therapies and worse survival, while haploidentical donors and older donor age were negative predictors for aGVHD-related deaths.

引用

页码：1577 / 1584

页数：8

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