학술논문
Reduced post-transplant cyclophosphamide dose with antithymocyte globulin in peripheral blood stem cell haploidentical transplantation.
Document Type
Academic Journal
Author
Duléry R; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. remy.dulery@aphp.fr.; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France. remy.dulery@aphp.fr.; Malard F; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.; Brissot E; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.; Banet A; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Sestili S; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Belhocine R; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Calabro M; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Van de Wyngaert Z; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Bonnin A; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Ledraa T; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Legrand O; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.; Labopin M; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation (EBMT) Paris Study Office/CEREST-TC, Paris, France.; Capderou E; Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Cohen A; Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Ederhy S; Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; Mohty M; Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
Source
Publisher: Nature Publishing Group Country of Publication: England NLM ID: 8702459 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5365 (Electronic) Linking ISSN: 02683369 NLM ISO Abbreviation: Bone Marrow Transplant Subsets: MEDLINE
Subject
Language
English
Abstract
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.
(© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)
(© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)