Post-Transplantation Cyclophosphamide based Graft-Versus-Host-Disease prophylaxis compared to Methotrexate-cyclosporine A in Matched Related Allogeneic Hematopoietic Stem Cell Transplantation

Mohamed Shouman, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, EgyptFollow
Osman Mansour, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Mosaad M. El Gammal, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Raafat Abdel-Fattah, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Mohamed A. Samra, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Alaa El Haddad, Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Mohamed Maher, Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
Hossam K. Mahmoud, Hematology and Bone Marrow Transplantation unit, National Cancer Institute, Cairo University, Cairo , Egypt

Abstract

Background: Post-transplant cyclophosphamide (PTCy) has shown promising results with low rates of severe graft-versus-host-disease (GVHD), either alone or combined with conventional immunosuppression (CIS). However, studies comparing PTCy with CIS as a GVHD prophylaxis are scarce.

Objective: The study aimed to evaluate the rates of GVHD and survival outcomes in patients undergoing peripheral blood stem cell transplant (PBSCT) from HLA matched related donors (MRD) receiving PTCy based GVHD prophylaxis and to compare it with the outcomes of patients receiving methotrexate (MTX) and cyclosporine-A (CsA) as a GVHD prophylaxis.

Patients and Methods: Seventy-five patients with advanced hematologic malignancies who underwent MRD allogeneic hematopoietic cell transplantation (allo-HCT) were analyzed prospectively. Those patients received PTCy and CSA as a GVHD prophylaxis (therapeutic group). Their outcomes were compared with another 75 retrospectively collected patients who received methotrexate and CsA as a GVHD prophylaxis (historical group) from the same two transplant centers.

Results: The median recipient age in the PTCy/CsA group was 34 years and 28 years in MTX/CsA group. Peripheral blood was the only graft source used. All patients had a fully MRD with two patients having a one-antigen mismatched related donor within the PTCy/CsA group. The 1-year cumulative incidence (CI) of chronic GVHD was 13.4% with PTCy/CsA compared to 38.6% with MTX/CsA (P=.001). Acute GVHD CI across all grades was not different between both groups at 10.7% with PTCy/CsA and 14.7% with MTX/CsA (P=.46). At two years, the overall survival (OS) (54.4% vs 67.2%, P=0.282), disease-free survival (DFS) (54.1% vs 66.1%, P=0.358), relapse rates (27.4% vs 20.1%, P=0.245) and non-relapse mortality (NRM) (29.3% vs 25%, P=0.904) were not different between PTCy/CsA and MTX/CsA respectively.

Conclusion: PTCy-based GVHD prophylaxis in MRD transplant is feasible and has shown lower chronic GVHD rates without a significantly different risk of relapse or survival than MTX/CsA. More extensive studies are needed to confirm our results.

Recommended Citation

Shouman, Mohamed; Mansour, Osman; Gammal, Mosaad M. El; Abdel-Fattah, Raafat; Samra, Mohamed A.; Haddad, Alaa El; Maher, Mohamed; and Mahmoud, Hossam K. (2023) "Post-Transplantation Cyclophosphamide based Graft-Versus-Host-Disease prophylaxis compared to Methotrexate-cyclosporine A in Matched Related Allogeneic Hematopoietic Stem Cell Transplantation," Hematology/Oncology and Stem Cell Therapy: Vol. 16 : Iss. 4 , Article 13.
Available at: https://doi.org/10.56875/2589-0646.1065