Comparison of Tacrolimus and Post-Transplant Cyclophosphamide (PTCy) with Tacrolimus and Methotrexate (Tac/MTX) Gvhd Prophylaxis in Patients with AML Undergoing Transplantation from Matched Related or Unrelated Donors

Post transplant cyclophosphamide (PTCy), tacrolimus, and MMF GvHD prophylaxis makes transplantation from haploidentical donors feasible without T cell depletion. In matched donor transplant recipients, cumulative incidences of grades II-IV acute, grades III-IV acute, and chronic GVHD were 51%, 15%,...

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Published in:Biology of blood and marrow transplantation 2019-03, Vol.25 (3), p.S235-S236
Main Authors: Popat, Uday R., Saliba, Rima M, Olson, Amanda, Mehta, Rohtesh S., Ahmed, Sairah, Alousi, Amin M., Anderlini, Paolo, Al-Atrash, Gheath, Bashir, Qaiser, Ciurea, Stefan O., Hosing, Chitra M., Im, Jin Seon, Kebriaei, Partow, Khouri, Issa F., Marin, David, Molldrem, Jeffrey J, Nieto, Yago, Oran, Betul, Qazilbash, Muzaffar H., Rezvani, Katy, Rondon, Gabriela, Shpall, EJ J., Varma, Ankur, Andersson, Borje S., Champlin, Richard E.
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Language:English
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Summary:Post transplant cyclophosphamide (PTCy), tacrolimus, and MMF GvHD prophylaxis makes transplantation from haploidentical donors feasible without T cell depletion. In matched donor transplant recipients, cumulative incidences of grades II-IV acute, grades III-IV acute, and chronic GVHD were 51%, 15%, and 14%, respectively when single agent PTCy was used (Kanakry et al JCO 2014 32:3497-3505). However; as a single agent it was inferior to tacrolimus and methotrexate in another study (Alousi etal BBMT 2015, 906-912). We therefore hypothesized that addition of tacrolimus to PTCy may be needed to prevent severe acute GVHD and improve transplant outcomes. All patients with AML undergoing first allogeneic transplant from matched sibling or at least 9/10 matched unrelated donor between 1/1/2011 to 4/30/2018 were eligible for this retrospective study if they received a melphalan or timed sequential busulfan (course AUC 20,000 umol/min) based conditioning regimen. GVHD prophylaxis consisted of tacrolimus and methotrexate 5mg/m2 on day 1, 3, 6, and 11 in the Tac/MTX cohort (n=140); and cyclophosphamide 50mg/kg given on days 3 and 4 and tacrolimus in the PTCy cohort (n=76). Patient characteristics were similar in both cohorts except that patients in PTCy cohort were younger with a median age of 59 years versus 63.5 years (P
ISSN:1083-8791
1523-6536
DOI:10.1016/j.bbmt.2018.12.228