Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

Rima M. Saliba; Amin M. Alousi; Joseph Pidala; Mukta Arora; Stephen R. Spellman; Michael T. Hemmer; Tao Wang; Camille Abboud; Sairah Ahmed; Joseph H. Antin; Amer Beitinjaneh; David Buchbinder; Michael Byrne; Jean Yves Cahn; Hannah Choe; Rabi Hanna; Peiman Hematti; Rammurti T. Kamble; Carrie L. Kitko; Mary Laughlin; Lazaros Lekakis; Margaret L. MacMillan; Rodrigo Martino; Parinda A. Mehta; Taiga Nishihori; Sagar S. Patel; Miguel Angel Perales; Hemalatha G. Rangarajan; Olov Ringdén; Joseph Rosenthal; Bipin N. Savani; Kirk R. Schultz; Sachiko Seo; Takanori Teshima; Marjolein van der Poel; Leo F. Verdonck; Daniel Weisdorf; Baldeep Wirk; Jean A. Yared; Jeffrey Schriber; Richard E. Champlin; Stefan O. Ciurea

doi:10.1016/j.jtct.2022.07.013

Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

Rima M. Saliba, Amin M. Alousi, Joseph Pidala, Mukta Arora, Stephen R. Spellman, Michael T. Hemmer, Tao Wang, Camille Abboud, Sairah Ahmed, Joseph H. Antin, Amer Beitinjaneh, David Buchbinder, Michael Byrne, Jean Yves Cahn, Hannah Choe, Rabi Hanna, Peiman Hematti, Rammurti T. Kamble, Carrie L. Kitko, Mary LaughlinLazaros Lekakis, Margaret L. MacMillan, Rodrigo Martino, Parinda A. Mehta, Taiga Nishihori, Sagar S. Patel, Miguel Angel Perales, Hemalatha G. Rangarajan, Olov Ringdén, Joseph Rosenthal, Bipin N. Savani, Kirk R. Schultz, Sachiko Seo, Takanori Teshima, Marjolein van der Poel, Leo F. Verdonck, Daniel Weisdorf, Baldeep Wirk, Jean A. Yared, Jeffrey Schriber, Richard E. Champlin, Stefan O. Ciurea

Research output: Contribution to journal › Article › peer-review

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Abstract

Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] =. 4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR =. 6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR =. 6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR =. 9, P =. 6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.

Original language	English (US)
Pages (from-to)	681-693
Number of pages	13
Journal	Transplantation and Cellular Therapy
Volume	28
Issue number	10
DOIs	https://doi.org/10.1016/j.jtct.2022.07.013
State	Published - Oct 2022

Bibliographical note

Publisher Copyright:
© 2022 The American Society for Transplantation and Cellular Therapy

Keywords

Graft-versus-host disease
Non-relapse mortality
Post-transplantation cyclophosphamide
Prophylaxis

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

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Saliba, R. M., Alousi, A. M., Pidala, J., Arora, M., Spellman, S. R., Hemmer, M. T., Wang, T., Abboud, C., Ahmed, S., Antin, J. H., Beitinjaneh, A., Buchbinder, D., Byrne, M., Cahn, J. Y., Choe, H., Hanna, R., Hematti, P., Kamble, R. T., Kitko, C. L., ... Ciurea, S. O. (2022). Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis. Transplantation and Cellular Therapy, 28(10), 681-693. https://doi.org/10.1016/j.jtct.2022.07.013

Saliba, RM, Alousi, AM, Pidala, J, Arora, M, Spellman, SR, Hemmer, MT, Wang, T, Abboud, C, Ahmed, S, Antin, JH, Beitinjaneh, A, Buchbinder, D, Byrne, M, Cahn, JY, Choe, H, Hanna, R, Hematti, P, Kamble, RT, Kitko, CL, Laughlin, M, Lekakis, L, MacMillan, ML, Martino, R, Mehta, PA, Nishihori, T, Patel, SS, Perales, MA, Rangarajan, HG, Ringdén, O, Rosenthal, J, Savani, BN, Schultz, KR, Seo, S, Teshima, T, van der Poel, M, Verdonck, LF, Weisdorf, D, Wirk, B, Yared, JA, Schriber, J, Champlin, RE & Ciurea, SO 2022, 'Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis', Transplantation and Cellular Therapy, vol. 28, no. 10, pp. 681-693. https://doi.org/10.1016/j.jtct.2022.07.013

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title = "Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis",

abstract = "Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] =. 4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR =. 6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR =. 6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR =. 9, P =. 6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.",

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doi = "10.1016/j.jtct.2022.07.013",

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AU - Saliba, Rima M.

AU - Alousi, Amin M.

AU - Pidala, Joseph

AU - Arora, Mukta

AU - Spellman, Stephen R.

AU - Hemmer, Michael T.

AU - Wang, Tao

AU - Abboud, Camille

AU - Ahmed, Sairah

AU - Antin, Joseph H.

AU - Beitinjaneh, Amer

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AU - Kamble, Rammurti T.

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AU - Laughlin, Mary

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AU - MacMillan, Margaret L.

AU - Martino, Rodrigo

AU - Mehta, Parinda A.

AU - Nishihori, Taiga

AU - Patel, Sagar S.

AU - Perales, Miguel Angel

AU - Rangarajan, Hemalatha G.

AU - Ringdén, Olov

AU - Rosenthal, Joseph

AU - Savani, Bipin N.

AU - Schultz, Kirk R.

AU - Seo, Sachiko

AU - Teshima, Takanori

AU - van der Poel, Marjolein

AU - Verdonck, Leo F.

AU - Weisdorf, Daniel

AU - Wirk, Baldeep

AU - Yared, Jean A.

AU - Schriber, Jeffrey

AU - Champlin, Richard E.

AU - Ciurea, Stefan O.

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AB - Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGvHD rate after Haplo/PTCY was also lower (hazard ratio [HR] =. 4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR =. 6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR =. 6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) during, but not after (HR =. 9, P =. 6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.

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KW - Non-relapse mortality

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KW - Prophylaxis

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Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

Abstract

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