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A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia: A Multicenter Study

2018; Elsevier BV; Volume: 24; Issue: 6 Linguagem: Inglês

10.1016/j.bbmt.2018.01.031

1523-6536

Patrizia Chiusolo, Gesine Bug, Attilio Olivieri, Mats Brune, Nicola Mordini, P Alessandrino, Alida Dominietto, Anna Maria Raiola, Carmen Di Grazia, Francesca Gualandi, Maria Teresa Van Lint, Felicetto Ferrara, Olimpia Finizio, Emanuele Angelucci, Andrea Bacigalupo,

Acute Lymphoblastic Leukemia research

Highlights•Favorable outcome of a modified PT-CY regimen, with cyclosporin given before PT-CY.•It is associated with a very low rate of relapse in remission patients.•We have seen a low incidence of GVHD, despite the use of cyclosporine before PT-CY.•These results may not translate automatically to unmanipulated peripheral blood.AbstractWe report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17–74) years, 51 (34%) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92%, 17%, and 15%, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20% and 24%, respectively. Four-year survival for remission patients was 72% (74% versus 67% for <60 or ≥60 years of age) and 26% for advanced patients (17% versus 41% for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age.