Single-Agent GvHD prophylaxis with tacrolimus after post-Transplant high-dose cyclophosphamide is a valid option for haploidentical transplantation in adults with hematological malignancies

A. Esquirol, M. J. Pascual, M. Ortiz, J. L. Piñana, C. Ferra, I. Garcia Cadenas, I. Vilades, S. Brunet, R. Martino, J. Sierra

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5 Citations (Scopus)

Abstract

© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. Eighty-one patients with high-risk hematological malignancies received unmanipulated haploidentical stem cell transplants (haploSCT) using the same protocol at four Spanish institutions. The conditioning regimen was thiotepa, busulfan and fludarabine; following bone marrow or peripheral blood infusion. GvHD prophylaxis with high-dose cyclophosphamide on days +3 and +4, and IV tacrolimus from day +5 was administered. 62% were in complete remission, 17% had received previous allogeneic SCT and 44% had a high-very high refined disease risk index. One patient had primary graft failure and three more died before +21. The median days to neutrophil and platelet recoveries were +18 and +23, respectively, and 93% achieved a full donor chimerism on day +30. At 1 year, cumulative incidences (CumInc) of non-relapse mortality and relapse were 27 and 19%. One-year overall survival and PFS were 61 and 51%. CumInc of grade II'IV and III'IV were 23 and 14%. At 30 months, CumInc of limited and extensive GvHD were 20 and 22%. In conclusion, patients with hematological malignancies who receive an unmanipulated haploSCT with post-Transplant cyclophosphamide may benefit from less intense pharmacological prophylaxis for GvHD prophylaxis. Whether this approach potentiates the graft-versus-Tumor effect and decreases relapses requires further investigation.
Original languageEnglish
Pages (from-to)1273-1279
JournalBone Marrow Transplantation
Volume52
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017

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