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IACH 2018 | Calcineurin and mTOR inhibitor-free graft-versus-host disease prevention

Sep 29, 2018

The  1st Annual Meeting of the International Academy for Clinical Hematology (IACH) took place in Paris, France, on September 27–29, 2018. On Friday 28 September, a non-Hodgkin lymphoma session was held, with an abstract presented entitled “Calcineurin and mTOR inhibitor-free GvHD prophylaxis” by Dr. Samer Al-Homsi from NYU Langone Health, New York, NY, USA.

The combination of methotrexate or mycophenolate mofetil (MMF) and a calcineurin or mTOR inhibitor for graft-versus-host disease (GvHD) prophylaxis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) have shown modest clinical activity. Furthermore, these regimens have unfavorable safety profiles, impair immune reconstitution, and weaken graft-versus-tumor (GvT) effect. There is an unmet need to develop new, more efficient strategies for the prophylaxis of GvHD.

  • Calcineurin and mTOR inhibitor-free GvHD prophylaxis seems effective, feasible and safe in matched-related and unrelated-donor transplantation
  • A novel combination of post-transplantation cyclophosphamide (PTC) and bortezomib for GvHD prophylaxis may allow wider applicability of allo-HSCT and early introduction of small molecules and immunologics to prevent relapse
  • PTC and bortezomib may be a feasible alternative for patients with renal insufficiency
  • PTC and ixazomib combination yielded more efficient suppression of tumor necrosis factor (TNF)-α as well as was able to rescue more mice than either of these drugs given alone as monotherapy

Dr. Samer Al-Homsi concluded by stating that calcineurin and mTOR inhibitor-free GvHD prevention seems feasible with a modest toxicity profile. Further trials are underway to confirm these findings.

  1. Al-Homsi S. et al. Calcineurin and mTOR inhibitor-free GvHD prophylaxis. 1st Annual Meeting of the International Academy for Clinical Hematology (IACH), Paris, France.