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Comparison of three GvHD prophylaxis regimens post-haploSCT
By Ella Dixon
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In patients undergoing haploSCT, the standard GvHD prophylaxis used after PTCy is CNI + MMF. However, studies have found promising results with the use of single-agent tacrolimus, and sirolimus + MMF prophylaxis. Recently a study published in Transplantation and Cellular Therapy retrospectively analyzed and compared the incidence of GvHD and survival outcomes with three GvHD prophylaxis strategies in adults undergoing haploSCT across five centers in Spain:
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| Key learnings |
| Multivariate analysis showed no significant differences in the incidence of grade II–IV aGvHD between patients who received single-agent tacrolimus, CNI + MMF, or sirolimus + MMF (20%, 25%, and 30%, respectively; p = 0.08) or grade III–IV aGvHD (9%, 6%, and 15%, respectively; p = 0.12) at 100 days. |
| Use of single-agent tacrolimus was associated with a lower incidence (p = 0.001) of cGvHD at 34 months (24%) compared with CNI + MMF (47%) and sirolimus + MMF (52%). |
| There were no differences in 3-year OS, PFS, NRM, or relapse rates observed between groups; DRI low-intermediate, HCT-CI <2, and EBMT <3 pretransplantation scores significantly impacted OS and PFS similarly between treatment groups. |
| All three prophylactic strategies gave similar survival outcomes; therefore, sirolimus + MMF may be a viable option for patients intolerant to CNI. The reduced risk of cGvHD noted with single-agent tacrolimus is a potential area of further investigation. |
Abbreviations: aGvHD, acute GvHD; CNI, calcineurin inhibitors; cGvHD, chronic GvHD; DRI, Disease Risk Index; EBMT, European Society for Blood and Marrow Transplantation; GvHD, graft-versus-host disease; HCT-CI, Hematopoietic Stem Cell-Specific Comorbidity Index; MMF, mycophenolate mofetil; non-relapse mortality; OS, overall survival; PFS, progression-free survival; PTCy, post-transplant cyclophosphamide.
- Esquirol A, Pascual MJ, Montoro J, et al. Comparison of three graft-versus-host disease prophylaxis strategies after T cell-replete haploidentical hematopoietic transplantation: tacrolimus versus calcineurin inhibitors + mycophenolate mofetil versus sirolimus + mycophenolate mofetil. Transplant Cell Ther. 2024;30(10):1025.e1-1025.e14. DOI: 1016/j.jtct.2024.07.027
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