Skip to main content
Erschienen in:

28.02.2022 | Original Article

Antithymocyte globulin plus post-transplant cyclophosphamide combination as graft-versus-host disease prophylaxis in haploidentical peripheral blood stem cell transplantation for hematological malignancies

verfasst von: Tzu-Ting Chen, Ching-Chan Lin, Wen-Jyi Lo, Ching-Yun Hsieh, Ming-Yu Lien, Che-Hung Lin, Chen-Yuan Lin, Li-Yuan Bai, Chang-Fang Chiu, Su-Peng Yeh

Erschienen in: International Journal of Hematology | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Post-transplant cyclophosphamide (PT-Cy) and calcineurin inhibitors used in peripheral blood haplo-identical stem cell transplantation (haploSCT) increase the risk of acute/chronic graft-versus-host disease (GVHD). Whether ATG/PT-Cy is feasible for Asian patients undergoing haploSCT is unclear, and an optimal strategy for GVHD prophylaxis is needed.

Materials and methods

We retrospectively analyzed 61 hematologic malignancy patients who underwent peripheral blood haploSCT using ATG/PT-Cy from January 2013 to December 2018. We also compared the effects of ATG/PT-Cy (ATG group; n = 61) with historical data from patients who underwent haploSCT using sirolimus/PT-Cy (non-ATG group; n = 22).

Results

Cumulative incidences of grades II–IV acute GVHD and moderate to severe chronic GVHD did not differ significantly. The ATG group had higher incidence of Epstein–Barr virus (EBV) reactivation, but neither group had post-transplant lymphoproliferative disorders. The ATG group also had a higher OS rate (2-year OS in ATG group vs. non-ATG group: 43.4% vs. 27.3%, respectively; P = 0.071).

Conclusion

ATG/PT-Cy is an acceptable strategy for GVHD prophylaxis in Asian patients undergoing haploSCT.
Literatur
1.
Zurück zum Zitat Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, et al. Haploidentical transplantation using T cell replete peripheral blood stem cells and myeloablative conditioning in patients with high-risk hematologic malignancies who lack conventional donors is well tolerated and produces excellent relapse-free survival: results of a prospective phase II trial. Biol Blood Marrow Transplant. 2012;18:1859–66. https://doi.org/10.1016/j.bbmt.2012.06.019.CrossRefPubMed Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, et al. Haploidentical transplantation using T cell replete peripheral blood stem cells and myeloablative conditioning in patients with high-risk hematologic malignancies who lack conventional donors is well tolerated and produces excellent relapse-free survival: results of a prospective phase II trial. Biol Blood Marrow Transplant. 2012;18:1859–66. https://​doi.​org/​10.​1016/​j.​bbmt.​2012.​06.​019.CrossRefPubMed
2.
Zurück zum Zitat Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, et al. Total body irradiation-based myeloablative haploidentical stem cell transplantation is a safe and effective alternative to unrelated donor transplantation in patients without matched sibling donors. Biol Blood Marrow Transplant. 2015;21:1299–307. https://doi.org/10.1016/j.bbmt.2015.03.003.CrossRefPubMed Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, et al. Total body irradiation-based myeloablative haploidentical stem cell transplantation is a safe and effective alternative to unrelated donor transplantation in patients without matched sibling donors. Biol Blood Marrow Transplant. 2015;21:1299–307. https://​doi.​org/​10.​1016/​j.​bbmt.​2015.​03.​003.CrossRefPubMed
6.
Zurück zum Zitat Cieri N, Greco R, Crucitti L, Morelli M, Giglio F, Levati G, et al. Post-transplantation cyclophosphamide and sirolimus after haploidentical hematopoietic stem cell transplantation using a treosulfan-based myeloablative conditioning and peripheral blood stem cells. Biol Blood Marrow Transplant. 2015;21:1506–14. https://doi.org/10.1016/j.bbmt.2015.04.025.CrossRefPubMed Cieri N, Greco R, Crucitti L, Morelli M, Giglio F, Levati G, et al. Post-transplantation cyclophosphamide and sirolimus after haploidentical hematopoietic stem cell transplantation using a treosulfan-based myeloablative conditioning and peripheral blood stem cells. Biol Blood Marrow Transplant. 2015;21:1506–14. https://​doi.​org/​10.​1016/​j.​bbmt.​2015.​04.​025.CrossRefPubMed
10.
Zurück zum Zitat Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825–8.PubMed Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825–8.PubMed
12.
Zurück zum Zitat Pavletic SZ, Kumar S, Mohty M, de Lima M, Foran JM, Pasquini M, et al. NCI first international workshop on the biology, prevention, and treatment of relapse after allogeneic hematopoietic stem cell transplantation: report from the Committee on the Epidemiology and Natural History of Relapse following Allogeneic Cell Transplantation. Biol Blood Marrow Transplant. 2010;16:871–90. https://doi.org/10.1016/j.bbmt.2010.04.004.CrossRefPubMedPubMedCentral Pavletic SZ, Kumar S, Mohty M, de Lima M, Foran JM, Pasquini M, et al. NCI first international workshop on the biology, prevention, and treatment of relapse after allogeneic hematopoietic stem cell transplantation: report from the Committee on the Epidemiology and Natural History of Relapse following Allogeneic Cell Transplantation. Biol Blood Marrow Transplant. 2010;16:871–90. https://​doi.​org/​10.​1016/​j.​bbmt.​2010.​04.​004.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Dao-Pei L, Lujia D, Tong W, Xiao-Jun H, Mei-Jie Z, Wei H. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation. Blood. 2006;107(8):3065–73. https://doi.org/10.1182/blood-2005-05-2146.CrossRef Dao-Pei L, Lujia D, Tong W, Xiao-Jun H, Mei-Jie Z, Wei H. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation. Blood. 2006;107(8):3065–73. https://​doi.​org/​10.​1182/​blood-2005-05-2146.CrossRef
18.
Zurück zum Zitat Law AD, Salas MQ, Lam W, Michelis FV, Thyagu S, Kim DDH, et al. Reduced-intensity conditioning and dual T lymphocyte suppression with antithymocyte globulin and post-transplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical hematopoietic stem cell transplants for hematological malignancies. Biol Blood Marrow Transplant. 2018;24:2259–64. https://doi.org/10.1016/j.bbmt.2018.07.008.CrossRefPubMedPubMedCentral Law AD, Salas MQ, Lam W, Michelis FV, Thyagu S, Kim DDH, et al. Reduced-intensity conditioning and dual T lymphocyte suppression with antithymocyte globulin and post-transplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical hematopoietic stem cell transplants for hematological malignancies. Biol Blood Marrow Transplant. 2018;24:2259–64. https://​doi.​org/​10.​1016/​j.​bbmt.​2018.​07.​008.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Finke J, Bethge WA, Schmoor C, Ottinger HD, Stelljes M, Zander AR, et al. Standard graft-versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a Randomised, Open-Label, Multicentre phase 3 Trial. Lancet Oncol. 2009;10:855–64. https://doi.org/10.1016/s1470-2045(09)70225-6.CrossRefPubMed Finke J, Bethge WA, Schmoor C, Ottinger HD, Stelljes M, Zander AR, et al. Standard graft-versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a Randomised, Open-Label, Multicentre phase 3 Trial. Lancet Oncol. 2009;10:855–64. https://​doi.​org/​10.​1016/​s1470-2045(09)70225-6.CrossRefPubMed
24.
Zurück zum Zitat Peccatori J, Forcina A, Clerici D, Crocchiolo R, Vago L, Stanghellini MT, et al. Sirolimus-based graft-versus-host disease prophylaxis promotes the in vivo expansion of regulatory T cells and permits peripheral blood stem cell transplantation from haploidentical donors. Leukemia. 2015;29:396–405. https://doi.org/10.1038/leu.2014.180.CrossRefPubMed Peccatori J, Forcina A, Clerici D, Crocchiolo R, Vago L, Stanghellini MT, et al. Sirolimus-based graft-versus-host disease prophylaxis promotes the in vivo expansion of regulatory T cells and permits peripheral blood stem cell transplantation from haploidentical donors. Leukemia. 2015;29:396–405. https://​doi.​org/​10.​1038/​leu.​2014.​180.CrossRefPubMed
Metadaten
Titel
Antithymocyte globulin plus post-transplant cyclophosphamide combination as graft-versus-host disease prophylaxis in haploidentical peripheral blood stem cell transplantation for hematological malignancies
verfasst von
Tzu-Ting Chen
Ching-Chan Lin
Wen-Jyi Lo
Ching-Yun Hsieh
Ming-Yu Lien
Che-Hung Lin
Chen-Yuan Lin
Li-Yuan Bai
Chang-Fang Chiu
Su-Peng Yeh
Publikationsdatum
28.02.2022
Verlag
Springer Singapore
Erschienen in
International Journal of Hematology / Ausgabe 4/2022
Print ISSN: 0925-5710
Elektronische ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-021-03280-x

Neu im Fachgebiet Onkologie

NRG1-Fusionen als neues, klinisch relevantes Target

Ergebnisse einer Phase-II-Studie deuten darauf hin, dass ein gegen HER3 und HER2 gerichteter Antikörper bei verschiedenen NRG1-Fusions-positiven Tumoren wirksam sein könnte. In den USA ist die Substanz bereits beschleunigt zugelassen worden.

Die aktuelle S3-Leitlinie zu CLL strotzt vor Neuerungen

Vor kurzem wurde eine neue, grundlegend überarbeite Version der S3-Leitlinie Chronische Lymphatische Leukämie (CLL) veröffentlicht.  Zu den wichtigsten Änderungen gehört, dass die Chemoimmuntherapie auf dem Rückzug ist.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

Wechsel von Zugangsroute und Biopsiesteuerung: Erfahrungen eines Zentrums

Geht der Switch zur transperinealen gezielten Prostatabiopsie auf Kosten der diagnostischen Qualität? Nein, urteilen norwegische Urologinnen und Urologen nach Durchsicht von Daten aus ihrer Einrichtung.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.