Single-agent GvHD prophylaxis with tacrolimus after post-transplant high-dose cyclophosphamide is a valid option for haploidentical transplantation in adults with hematological malignancies

Bone Marrow Transplant. 2017 Sep;52(9):1273-1279. doi: 10.1038/bmt.2017.111. Epub 2017 Jun 12.

Abstract

Eighty-one patients with high-risk hematological malignancies received unmanipulated haploidentical stem cell transplants (haploSCT) using the same protocol at four Spanish institutions. The conditioning regimen was thiotepa, busulfan and fludarabine; following bone marrow or peripheral blood infusion. GvHD prophylaxis with high-dose cyclophosphamide on days +3 and +4, and IV tacrolimus from day +5 was administered. 62% were in complete remission, 17% had received previous allogeneic SCT and 44% had a high-very high refined disease risk index. One patient had primary graft failure and three more died before +21. The median days to neutrophil and platelet recoveries were +18 and +23, respectively, and 93% achieved a full donor chimerism on day +30. At 1 year, cumulative incidences (CumInc) of non-relapse mortality and relapse were 27 and 19%. One-year overall survival and PFS were 61 and 51%. CumInc of grade II-IV and III-IV were 23 and 14%. At 30 months, CumInc of limited and extensive GvHD were 20 and 22%. In conclusion, patients with hematological malignancies who receive an unmanipulated haploSCT with post-transplant cyclophosphamide may benefit from less intense pharmacological prophylaxis for GvHD prophylaxis. Whether this approach potentiates the graft-versus-tumor effect and decreases relapses requires further investigation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cyclophosphamide / pharmacology
  • Cyclophosphamide / therapeutic use*
  • Female
  • Graft vs Host Disease / prevention & control*
  • Hematologic Neoplasms / drug therapy*
  • Hematologic Neoplasms / pathology
  • Hematologic Neoplasms / therapy*
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tacrolimus / pharmacology
  • Tacrolimus / therapeutic use*
  • Transplantation Conditioning / methods*
  • Transplantation, Haploidentical / methods*
  • Young Adult

Substances

  • Immunosuppressive Agents
  • Cyclophosphamide
  • Tacrolimus