Different risk factors of acute and chronic graft-versus-host disease with conventional prophylaxis and posttransplantation cyclophosphamide in matched related and unrelated donor transplantations

Abstract

Novel aspects of allogeneic stem cell transplantation (HSCT) technologies, like use of peripheral blood stem cells (PBSC), or usage of unrelated donors signifi cantly change the risk factors of graft-versus-host disease. Little is known, whether novel prophylaxis regimens also alter the risk factor pattern. In this study we evaluated risk factors of grade II-IV acute GVHD, and moderate or severe (NIH) chronic GVHD in the cohort of 199/344 related/ unrelated patients subjected to conventional prophylaxis with calcineurin inhibitor plus methotrexate/mycophenolate mofetil (MMF) ± antithymocyte globuline. Another cohort included 104/365 recipients of related/ unrelated graft s with either single-agent posttransplant cyclophosphamide (PTCy), or its combination with tacrolimus and MMF, respectively. We have observed that, for the conventional prophylaxis, the signifi cant factors for acute GVHD were unrelated donor (HR 1.86, 95%CI 1.11-3.19, p=0.0219), salvage disease status at transplant (HR 0.50, 95%CI 0.30-0.79), use of RIC (HR 0.58, 95%CI 0.40-0.85), older age (HR 0.0442, 95%CI 0.96-0.99), higher BMI (HR 0.97, 95%CI 0.97-1.00) and early engraft ment (HR 1.55, 95%CI 1.08-2.22).

Outcomes of allogeneic hematopoietic stem cell transplantation in children and adults with prior invasive fungal diseases

“…In 2017, 18.281 number of allo-HSCT were performed in Europe and associated countries reported by 683 centers in 50 countries, with acute leukemia being the main indication [1]. The approachability and outcome of allo-HSCT are steadily improving due to wide application of reduced-intensity conditioning (RIC), new methods of graft-versus-host disease (GvHD) prophylaxis, haploidentical transplantation, and introduction of novel molecules and drugs for bridge therapy before allo-HSCT, along with prevention and treatment of relapses after allo-HSCT both in adults and pediatric patients [2][3][4][5][6][7][8] Invasive fungal disease (IFD) is a common infectious complication during remission-induction and/or consolidation chemotherapy for aggressive hematologic malignancies. The patients with acute leukemia and high-risk myelodysplastic syndrome are also at high risk for IFD [9][10].…”