1. Graft versus host disease in unmanipulated haploidentical marrow transplantation with a modified post-transplant cyclophosphamide (PT-CY) regimen: an update on 425 patients
- Author
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Bacigalupo, Andrea, Maria Raiola, A., Dominietto, A., Di Grazia, C., Gualandi, F., Lint, M. T. V., Chiusolo, Patrizia, Laurenti, Luca, Sora', Federica, Giammarco, S., Angelucci, E., Bacigalupo A. (ORCID:0000-0002-9119-567X), Chiusolo P. (ORCID:0000-0002-1355-1587), Laurenti L. (ORCID:0000-0002-8327-1396), Sora F. (ORCID:0000-0002-9607-5298), Bacigalupo, Andrea, Maria Raiola, A., Dominietto, A., Di Grazia, C., Gualandi, F., Lint, M. T. V., Chiusolo, Patrizia, Laurenti, Luca, Sora', Federica, Giammarco, S., Angelucci, E., Bacigalupo A. (ORCID:0000-0002-9119-567X), Chiusolo P. (ORCID:0000-0002-1355-1587), Laurenti L. (ORCID:0000-0002-8327-1396), and Sora F. (ORCID:0000-0002-9607-5298)
- Abstract
This is an update on acute and chronic graft-versus-host disease (GvHD) in 425 patients with hematologic malignancies, undergoing an unmanipulated haploidentical (HAPLO) graft from related donors, with a modified post-transplant cyclophosphamide (PT-CY) regimen. All patients received a myeloablative conditioning regimen, either based on thiotepa busulfan fludarabine (TBF), or on full-dose total body irradiation (TBI). The cumulative incidence of acute GvHD-grade II–IV was 29%, and the CI of GvHD-grade III–IV was 4%. We found older donors and older patients to have higher rates of grade II–IV acute GvHD; female donors, diagnosis, disease phase, year of transplant, and the conditioning regimen had no predictive effect on acute GvHD. There was no impact of grade II GvHD, but a significant impact of grade III–IV acute GvHD, on overall survival. The CI of moderate–severe chronic GvHD was 18%: the major predictor was a previous acute GvHD, followed by combined donor and recipients age. In conclusion, PT-CY given on days+3 + 5 results in a relatively low, but not insignificant risk of acute and chronic GvHD, in patients grafted from the related HAPLO donors. The use of young donors appears to reduce this risk.
- Published
- 2019