Posttransplantation cyclophosphamide (PTCy) with tacrolimus (TK) was safe and effective as a prophylaxis for graft-versus-host disease (GVHD) in patients aged 50 and older with hematologic malignancies. These findings were published in Transplantation and Cellular Therapy.
PTCy has been found to decrease the rate of GVHD. However, there remains a paucity of data about PTCy safety and efficacy among older patients.
For this study, 161 patients with hematologic malignancies, aged 50 years and older, who underwent first allogeneic hematopoietic stem cell transplantation from sibling, matched and mismatched donors between January 2014 and February 2021 at Hospital Clinic de Barcelona in Spain were included. Outcomes were compared between use of PTCy-TK (88 patients) and other prophylaxis regimens (78 patients).
Patients were median age 60 years (range, 50 to 70), 55.3% were men, 36.0% had acute myeloid leukemia, 31.8% had myelodysplastic syndrome or chronic myelomonocytic leukemia, and 65.2% had low to moderate disease risk.
GVHD occurred among one PTCy-TK recipient compared with 10 recipients of other prophylaxis regimens.
PTCy-TK recipients had higher rates of bloodstream infection (16.5% vs 4.3%; P =.015), mucositis (35.2% vs 19.1%; P =.024), and BK-virus-associated hemorrhagic cystitis (11.4% vs 2.7%; P =.038).
PTCy-TK use resulted in comparable 2-year overall survival (65.4% vs 65.6%), relapse-free survival (58.4% vs 58.8%), and superior GVHD- or relapse-free survival (50.2% vs 21.8%; P <.001) compared with other regimens.
PTCy-TK associated with decreased risk for grade II-IV acute GVHD (hazard ratio [HR], 0.32; P =.014), chronic GVHD (HR, 0.43; P =.013), and moderate to severe chronic GVHD (HR, 0.10; P <.001).
A limitation of this study was its retrospective, single institution design.
PTCy-TK associated with decreased GVHD risk among older patients receiving stem cell transplant with similar survival rates compared with other prophylaxis regimens.
Salas MQ, Charry P, Pedraza A, et al. PTCY and tacrolimus for GVHD prevention for older adults undergoing HLA-matched sibling and unrelated donor alloHCT. Transplant Cell Ther. Published online May 14, 2022. doi:10.1016/j.jtct.2022.05.009