Ex vivo T‐cell depletion vs post‐transplant cyclophosphamide, sirolimus, and mycophenolate mofetil as graft‐vs‐host disease prophylaxis for allogeneic hematopoietic stem cell transplantation.

Objective: To compare the efficacy and safety of CD34+ selected ex vivo T‐cell depletion (TCD) vs post‐transplant cyclophosphamide, sirolimus, and mycophenolate mofetil (PTCy‐Sir‐MMF) as graft‐vs‐host disease (GVHD) prophylaxis. Methods: We retrospectively included patients who underwent allogeneic hematopoietic stem cell transplantation (allo‐HSCT) with either TCD (n = 38) or PTCy‐Sir‐MMF (n = 91). Results: Cumulative incidence of neutrophil and platelet recovery was 92% vs 99% (P =.06) and 89% vs 97% (P =.3) in TCD and PTCy‐Sir‐MMF, respectively. Cumulative incidences of aGHVD grade II‐IV, III‐IV, and moderate to severe cGVHD were 11% vs 19% (P =.2), 3% vs 2% (P =.9), and 3% vs 36% (P <.001) in TCD and PTCy‐Sir‐MMF, respectively. The 2‐year non‐relapse mortality, relapse, disease‐free and overall survival were 25% vs 8% (P =.01), 20% vs 16% (P =.2), 55% vs 76% (P =.004), 57% vs 83% (P =.004) for TCD and PTCy‐Sir‐MMF, respectively. Cumulative incidence of cytomegalovirus and Epstein‐Barr infection requiring therapy was 76% vs 40% (P <.001) and 32% vs 0% (P <.001) in TCD and PTCy‐Sir‐MMF, respectively. PTCy‐Sir‐MMF platform showed faster T‐cell reconstitution. Conclusions: PTCy‐Sir‐MMF provides better survival outcomes but is associated with higher risk of cGVHD compared to TCD. [ABSTRACT FROM AUTHOR]