Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis

Bolaños-Meade, Javier; Hamadani, Mehdi; Wu, Juan; Malki, Monzr M. Al; Märtens, Michael; Runaas, Lyndsey; Elmariah, Hany; Rezvani, Andrew R.; Gooptu, Mahasweta; Larkin, Karilyn; Shaffer, Brian C.; Jurdi, Najla El; Loren, Alison W.; Solh, Melhem; Hall, Aric C.; Alousi, Amin M.; Jamy, Omer; Perales, Miguel-Ángel; Yao, Janny M.; Applegate, Kristy; Bhatt, Ami S.; Kean, Leslie S.; Efebera, Yvonne A.; Reshef, Ran; Clark, William; DiFronzo, Nancy L.; Leifer, Eric; Horowitz, Mary M.; Jones, Richard J.; Holtan, Shernan G.

doi:10.1056/nejmoa2215943

Cited by 156 publications

(39 citation statements)

References 35 publications

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“…In Europe, it has been standard of care to use rATG in alloSCTs with a high GVHD risk [ 2 ]. In the USA, the results of the CTN 1703 and CTN 1203 randomized trials [ 4 , 5 ], demonstrating a benefit of PTCy vs. no T-cell depletion, led to a widespread use of PTCy. The present study was designed to help answering the question if PTCy or rATG should be the preferred option.…”

Section: Discussionmentioning

confidence: 99%

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ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation?

Penack,

Abouqateb,

Peczynski

et al. 2024

Leukemia

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There is a high risk of GVHD and non-relapse mortality (NRM) after allogeneic stem cell transplantations (alloSCT) from unrelated donors. Prophylaxis with rabbit anti-thymocyte globulin (rATG) is standard in Europe but post-transplantation Cyclophosphamide (PTCy) is an emerging alternative. We analyzed outcomes of rATG (n = 7725) vs. PTCy (n = 1039) prophylaxis in adult patients with hematologic malignancies undergoing peripheral blood alloSCT from 10/10 antigen-matched unrelated donors (MUD) between January 2018 and June 2021 in the EBMT database. The provided P-values and hazard ratios (HR) are derived from multivariate analysis. Two years after alloSCT, NRM in the PTCy group was 12.1% vs. 16.4% in the rATG group; p = 0.016; HR 0.72. Relapse was less frequent after PTCy vs. rATG (22.8% vs. 26.6%; p = 0.046; HR 0.87). Overall survival after PTCy was higher (73.1% vs. 65.9%; p = 0.001, HR 0.82). Progression free survival was better after PTCy vs. rATG (64.9% vs. 57.2%; p < 0.001, HR 0.83). The incidence of chronic GVHD was lower after PTCy (28.4% vs. rATG 31.4%; p = 0.012; HR 0.77), whereas the incidence and severity of acute GVHD were not significantly different. GVHD-free relapse-free survival was significantly higher in the PTCy arm compared to the rATG arm (2 y incidence: 51% vs. 45%; HR: 0.86 [95% CI 0.75–0.99], p = 0.035). In the absence of evidence from randomized controlled trials, our findings support a preference for the use of PTCy in adult recipients of peripheral blood alloSCTs from MUD.

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Section: Discussionmentioning

confidence: 99%

“…The prevention strategies of GVHD are currently changing. Cyclophosphamide given after alloSCT (post-transplant Cyclophosphamide, PTCy) is another option, which is now standard of care in the USA [ 4 , 5 ] and is also increasingly used in some alloSCT centres in Europe.…”

Section: Introductionmentioning

confidence: 99%

ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation?

Penack,

Abouqateb,

Peczynski

et al. 2024

Leukemia

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“…To calculate target date for these visits, 1month = 30 days. 3 Onset visit only required if diagnosis date is more than 14 days before or after another study visit. 4 Cyto-Chex collected only at onset of cGVHD (per NIH consensus criteria).…”

Section: Provider Assessment Formmentioning

confidence: 99%

“…Chronic graft-versus-host disease (GVHD) is a common immune-mediated disorder following allogeneic hematopoietic cell transplantation (HCT). This complication develops in 10-30% of those who survive at least 100 days and has a median time to onset of 4-6 months after HCT [1][2][3]. Chronic GVHD is associated with worse quality of life [4][5][6], prolonged duration of immunosuppressive therapy (IST) [7,8], and higher non-relapse mortality, but also a lower malignancy relapse rate [9].…”

Section: Introductionmentioning

confidence: 99%

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Study protocol: Close Assessment and Testing for Chronic Graft-vs.-Host disease (CATCH)

Pidala,

Carpenter,

Onstad

et al. 2024

PLoS ONE

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Chronic graft-versus-host disease (GVHD) is an immune-mediated disorder that causes significant late morbidity and mortality following allogeneic hematopoietic cell transplantation. The “Close Assessment and Testing for Chronic GVHD (CATCH)” study is a multi-center Chronic GVHD Consortium prospective, longitudinal cohort study designed to enroll patients before hematopoietic cell transplantation and follow them closely to capture the development of chronic GVHD and to identify clinical and biologic biomarkers of chronic GVHD onset. Data are collected pre-transplant and every two months through one-year post-transplant with chart review thereafter. Evaluations include clinician assessment of chronic GVHD and its manifestations, patient-reported outcomes, multiple biospecimens (blood, saliva, tears, buccal mucosa and fecal samples, biopsies of skin and mouth), laboratory testing, and medical record abstraction. This report describes the rationale, design, and methods of the CATCH study, and invites collaboration with other investigators to leverage this resource. trial registration: This study is registered at www.clinicaltrials.gov as NCT04188912.

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Hematopoietic Cell Transplantation and Cellular Therapy in Acute Myeloid Leukemia

Kongtimand,

Ciurea

2023

Cancer Consult

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Post-Transplantation Cyclophosphamide-Based Graft-versus-Host Disease Prophylaxis

Cited by 156 publications

References 35 publications

ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation?

ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation?

Study protocol: Close Assessment and Testing for Chronic Graft-vs.-Host disease (CATCH)

Hematopoietic Cell Transplantation and Cellular Therapy in Acute Myeloid Leukemia

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