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Graft-versus-host disease prophylaxis with post-transplant cyclophosphamide in chronic myeloid leukemia patients undergoing allogeneic hematopoietic cell transplant from either an unrelated or mismatched related donor: a comparative study from the Chr..
Ortí, G. Gras, L. Koster, L. Kulagin, A. Byrne, J. Apperley, J. F. Halaburda, K. Blau, I. W. Clark, A. Kröger, N.
Ortí, G.
Gras, L.
Koster, L.
Kulagin, A.
Byrne, J.
Apperley, J. F.
Halaburda, K.
Blau, I. W.
Clark, A.
Kröger, N.
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Abstract
Outcomes following allogeneic hematopoietic cell transplant (allo-HCT) for Chronic Myeloid Leukemia (CML) with post-transplant cyclophosphamide (PTCy) utilising an unrelated donor (UD) or mismatched related donor (MMRD) remain unknown. We report on a retrospective comparison of PTCy based allo-HCT from an UD, non-PTCy allo-HCT from an UD and PTCy allo-HCT from a MMRD. Inclusion criteria were adult patients with CML undergoing first allo-HCT between 2012 to 2019 from an UD with either PTCy or non-PTCy GvHD prophylaxis and MMRD using PTCy. Primary endpoint was GvHD relapse-free survival (GRFS). A total of 1341 patients were included (82% in the non-PTCy UD cohort). With a median follow-up of 34.9 months, the 3-year GRFS was 43%, 37% and 39% in the non-PTCy UD, PTCy-UD and PTCy MMRD cohorts, respectively (p=0.15). In multivariable analyses, there were no significant differences between the three cohorts regarding OS, PFS, RI and NRM. Factors independently associated with worse OS in the overall cohort were KPS<90 (HR 1.86, 95%CI, 1.41-2.45; p<0.001), older age (HR 1.24, 95%CI, 1.11-1.38; p<0.001) and disease stage (compared to CP1) blast phase HR 2.25, 95% CI, 1.60-3.16; p<0.001, accelerated phase HR 1.63, 95% CI, 1.05-2.54; p=0.03 and CP>2 HR 1.58, 95% CI, 1.15-2.17; p=0.005. These results suggest that allo-HCT in CML utilizing either an UD or MMRD with a PTCy GvHD-based prophylaxis are feasible transplant platforms and that the disease stage at allo-HCT remains a major prognostic factor, highlighting the importance to closely monitor CML patients and propose transplantation when indicated, when still in CP1.
Authors
Ortí, G.
Gras, L.
Koster, L.
Kulagin, A.
Byrne, J.
Apperley, J. F.
Halaburda, K.
Blau, I. W.
Clark, A.
Kröger, N.
Griskevicius, L.
Carlson, K.
Collin, M.
Bloor, Adrian
Raiola, A. M.
Blaise, D.
Aljurf, M.
López-Corral, L.
Sakellari, I.
Beguin, Y.
Wrobel, T.
de Rosa, L.
de Lavallade, H.
Hayden, P. J.
McLornan, D.
Chalandon, Y.
Yakoub-Agha, I.
Gras, L.
Koster, L.
Kulagin, A.
Byrne, J.
Apperley, J. F.
Halaburda, K.
Blau, I. W.
Clark, A.
Kröger, N.
Griskevicius, L.
Carlson, K.
Collin, M.
Bloor, Adrian
Raiola, A. M.
Blaise, D.
Aljurf, M.
López-Corral, L.
Sakellari, I.
Beguin, Y.
Wrobel, T.
de Rosa, L.
de Lavallade, H.
Hayden, P. J.
McLornan, D.
Chalandon, Y.
Yakoub-Agha, I.
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Date
2023
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Article
Citation
Ortí G, Gras L, Koster L, Kulagin A, Byrne J, Apperley JF, et al. Graft-versus-Host Disease Prophylaxis with Post Transplant Cyclophosphamide in Chronic Myeloid Leukemia patients undergoing Allogeneic Hematopoietic Cell Transplant from either an Unrelated or Mismatched Related Donor: a comparative study from the Chr. Transplant Cell Ther. 2023 Sep 30. PubMed PMID: 37783337. Epub 2023/10/03. eng.