1. Anti-PD-1 combined with hypomethylating agent and CAG regimen bridging to allogeneic hematopoietic stem cell transplantation: a novel strategy for relapsed/refractory acute myeloid leukemia.
- Author
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Wang YX, Wang A, Su YF, Wang J, Li YH, Li F, Jing Y, Xu L, Wang YZ, Zheng X, Gao CJ, Hu LD, Gao XN, and Liu DH
- Subjects
- Humans, Male, Female, Adult, Middle Aged, Young Adult, Cytarabine therapeutic use, Cytarabine administration & dosage, Idarubicin administration & dosage, Idarubicin therapeutic use, Programmed Cell Death 1 Receptor antagonists & inhibitors, Immune Checkpoint Inhibitors therapeutic use, Adolescent, Treatment Outcome, Recurrence, Aged, Leukemia, Myeloid, Acute therapy, Leukemia, Myeloid, Acute mortality, Hematopoietic Stem Cell Transplantation adverse effects, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Antineoplastic Combined Chemotherapy Protocols adverse effects, Graft vs Host Disease prevention & control, Graft vs Host Disease etiology, Transplantation, Homologous, Granulocyte Colony-Stimulating Factor administration & dosage, Aclarubicin therapeutic use, Aclarubicin administration & dosage
- Abstract
Introduction: The prognosis of relapsed/refractory acute myeloid leukemia (r/rAML) is dismal, and allogeneic hematopoietic stem cell transplant (allo-HSCT) is a potential cure. Combining anti-PD-1, hypomethylating agent (HMA), and CAG (cytarabine, aclarubicin/idarubicin, granulocyte colony-stimulating factor) regimen has showed primary efficacy in r/rAML. However, pre-transplant exposure to anti-PD-1 may lead to severe graft-versus-host disease (GVHD). This preliminary study aimed to evaluate the safety and efficacy of allo-HSCT in r/rAML patients receiving the anti-PD-1+HMA+CAG regimen., Methods: Fifteen r/rAML patients (12 related haploidentical donors [HIDs], 2 matched siblings, 1 unrelated donor) received this regimen and subsequent peripheral blood HSCT., Results: Four patients with HIDs received a GVHD prophylaxis regimen consisted of Anti-thymocyte globulin and a reduced-dose of post-transplant cyclophosphamide. The median follow-up was 20.9 months (range, 1.2-34.2). The cumulative incidences of acute GVHD grade 2-4 and grade 3-4 were 40% and 13.3%, respectively. The 2-year incidence of moderate-to-severe chronic GVHD, non-relapse mortality, and relapse were 10%, 22.3%, and 22.5%, respectively. The 2-year overall survival and GVHD-free/relapse-free survival rates were 54% and 48.6%, respectively. No death or relapse was observed in the PTCy group., Conclusion: The anti-PD-1+HMA+CAG regimen bridging to allo-HSCT for r/r AML was tolerable with promising efficacy. GVHD prophylaxis with PTCy for HID-HSCT showed preliminary survival advantage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Wang, Su, Wang, Li, Li, Jing, Xu, Wang, Zheng, Gao, Hu, Gao and Liu.)
- Published
- 2024
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