The timing of immunosuppressive therapy used in combination with post-transplantation cyclophosphamide (PTCY) in haploidentical hematopoietic stem cell transplant (haplo-HSCT) is not standardized. We evaluated the schedules of immunosuppression therapy after haplo-HSCT in 509 patients with acute leukemia receiving PTCY on days +3 and +4 along with tacrolimus (group 1; n = 215), with cyclosporine A (CSA) and mycophenolate mofetil (MMF) from day +5 (group 2; n = 170), or CSA + MMF from day 0 or 1 with PTCY on days +3 and +5 (group 3; n = 124). Compared with the other 2 groups, patients in group 3 were younger (median age, 46 years; P = .02) and more often received bone marrow (77%; P < .01) and a regimen containing thiotepa, fludarabine, and busulfan (84%; P< .01). At 2 years, overall survival was 44% was in group 1, 48% in group 2, and 59% in group 3 (P= .15); leukemia-free survival (LFS) was 43%, 46%, and 53% (P= .05); and refined graft-versus-host disease-free, relapse-free survival (rGRFS) was 33%, 39%, and 36% (P = .02). The incidence of grade II-IV acute GVHD was 25% in group 1, 39% in group 2, and 18% in group 3 (P< .01); incidence of chronic GVHD was 25%, 21%, and 24% (P= .50); relapse incidence was 36%, 37%, and 26% (P= .02); and nonrelapse mortality was 26%, 20%, and 21% (P= .35). On multivariate analysis, early start of immunosuppression therapy at day +1 followed by PTCY was associated with a better LFS (hazard ratio [HR], .58; P= .02) and improved rGRFS (HR, .62; P = .02). In this study, the timing of immunosuppression influenced the outcomes of haplo-HSCT with PTCY. An early start of CSA + MMF with PTCY administered on days +3 and +5 improves LFS and rGRFS.

Department of Hematology Humanitas Clinical and Research Center Istituto di Ricovero e Cura a Carattere Scientifico Rozzano Italy

Hematology and Bone Marrow Transplant Unit IRCCS San Raffaele Scientific Institute Milan Italy

Hematology and Hemotherapy Department Hospital General Universitario Gregorio Marañón Madrid Spain

Hematology Department Federico 2 University Naples Italy

Hematology Department Service d'Hématologie et Thérapie Cellulaire Hôpital Saint Antoine Paris France; Sorbonne Universités INSERM Centre de Recherche Saint Antoine UPMC Univ Paris 06 Paris France; European Society for Blood and Marrow Transplantation Paris France

Hematology Service Institute of Hematology and Blood Transfusion Prague Czech Republic

Hospital Clinic BMT Unit Hematology Department Institute of Hematology and Oncology Institut d'Investigació Biomèdica August Pi 1 Sunyer University of Barcelona Institut Josep Carreras Barcelona Spain

Istituto di Ematologia Fondazione Policlinico Universitario Gemelli IRCCS Roma Italy

RM Gorbacheva Memorial Institute of Hematology Oncology and Transplantation Pavlov University Saint Petersburg Russian Federation

Sorbonne Universités INSERM Centre de Recherche Saint Antoine UPMC Univ Paris 06 Paris France; Hematology Division and Bone Marrow Transplantation Chaim Sheba Medical Center Tel Hashomer Israel

SSCVD Trapianto di Cellule Staminali AOU Città della Salute e della Scienza di Torino Turin Italy

University Hospital of Munich LMU Munich German

Biol Blood Marrow Transplant. 2020 Oct;26(10):e243-e244. doi: 10.1016/j.bbmt.2020.08.010. PubMed

Citace poskytuje Crossref.org

Tacrolimus versus cyclosporine a combined with post-transplantation cyclophosphamide for AML In first complete remission: a study from the acute leukemia working party (EBMT)