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BMT CTN 1703 post hoc analysis: PTCy-based GvHD prophylaxis in older patients
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A post hoc analysis of the BMT CTN 1703 trial (NCT03959241) evaluated the impact of PTCy/ Tac/ MMF vs Tac/MTX in GvHD prophylaxis in patients aged ≥70 years undergoing allo-HSCT from an HLA-matched donor (n = 96 randomized, n = 94 received transplant).1 Results were presented by Abedin at the 66th ASH Annual Meeting and Exposition.1 The primary endpoint was 1-year GFRS and secondary endpoints included GFS, TRM, and OS.1 |
| Key learnings |
| GvHD prophylaxis with PTCy/Tac/MMF was superior to Tac/MTX, resulting in higher GRFS (63.1% vs 29.9%; HR, 0.341; p < 0.001) and improved OS (90.6% vs 61.8%; HR, 0.186; p = 0.003). |
| Higher rates of GFS (72.4% vs 41.3%, p = 0.001) and systemic ISFS (60.0% vs 38.8%, p = 0.046) were seen in the PTCy/Tac/MMF vs Tac/MTX group. |
| Lower incidence of Grade 3 aGvHD and cGvHD were seen in the PTCy/Tac/MMF vs Tac/MTX group (0.0% vs 9.9%; p = 0.175 and 18.3% vs 24.4%; p = 0.089, respectively); 1-year TRM was also lower (4.6% vs 20.0%, p = 0.038). |
| PTCy-based GvHD prophylaxis improved GvHD control without increasing toxicity in older patients undergoing transplant. Future efforts aimed at reducing PTCy-related toxicity may help improve access to allo-HSCT in this population. |
Abbreviations: allo-HSCT, allogeneic hematopoietic stem cell transplantation; aGvHD, acute graft-versus-host disease; ASH, American Society of Hematology; BMT CTN, Blood and Marrow Transplant Clinical Trial Network; cGvHD, chronic graft-versus-host disease; GFS, graft-failure-free survival; GRFS, graft-versus-host disease-free relapse-free survival; HLA, human leukocyte antigen, ISFS, immunosuppressive free-survival; MMF, mycophenolate mofetil; MTX, methotrexate; OS, overall survival; PTCy, post-transplant cyclophosphamide; TRM, treatment-related mortality; Tac, tacrolimus.
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