Single-Agent Cyclosporine for Graft-versus-Host Disease Prophylaxis in Patients with Acquired Aplastic Anemia Receiving Fludarabine-Based Conditioning

Raheel Iftikhar , Qamar un Nisa Chaudhry , Syed Kamran Mahmood , Tariq Ghafoor , Humayun Shafique Satti , Nighat Shahbaz , Mehreen Ali Khan , Tariq Azam Khattak , Ghassan Umair Shamshad , Jahanzeb Rehman , Muhammad Farhan , Saima Humayun , Amina Risalat , Ahsan Wahab , Tariq Mehmood Satti , Faiz Anwer , Parvez Ahmed
{"title":"Single-Agent Cyclosporine for Graft-versus-Host Disease Prophylaxis in Patients with Acquired Aplastic Anemia Receiving Fludarabine-Based Conditioning","authors":"Raheel Iftikhar ,&nbsp;Qamar un Nisa Chaudhry ,&nbsp;Syed Kamran Mahmood ,&nbsp;Tariq Ghafoor ,&nbsp;Humayun Shafique Satti ,&nbsp;Nighat Shahbaz ,&nbsp;Mehreen Ali Khan ,&nbsp;Tariq Azam Khattak ,&nbsp;Ghassan Umair Shamshad ,&nbsp;Jahanzeb Rehman ,&nbsp;Muhammad Farhan ,&nbsp;Saima Humayun ,&nbsp;Amina Risalat ,&nbsp;Ahsan Wahab ,&nbsp;Tariq Mehmood Satti ,&nbsp;Faiz Anwer ,&nbsp;Parvez Ahmed","doi":"10.1016/j.bbmt.2020.07.026","DOIUrl":null,"url":null,"abstract":"<div><p>Cyclosporine (CsA) combined with short-course methotrexate is considered standard-of-care graft-versus-host disease (GVHD) prophylaxis for patients with severe aplastic anemia (AA) who undergo transplantation using cyclophosphamide (Cy) plus anti-thymocyte globulin (ATG) conditioning. However, there is no consensus on optimal post-transplant GVHD prophylaxis for patients undergoing matched related donor (MRD) transplantation using fludarabine (Flu)-based conditioning. We conducted a single-center retrospective analysis of patients with acquired AA (n = 106) undergoing MRD transplantation from July 2007 through January 2019. All patients received Flu-Cy-ATG conditioning and single-agent CsA as GVHD prophylaxis. Median age of the study cohort was 20 years (range, 3 to 52) and male to female ratio was 3.8:1. Median time from diagnosis to transplant was 11.5 months (range, 2.8 to 62). Graft source was bone marrow harvest in 71 (68%), combined bone marrow and peripheral blood stem cells in 34 (31%), and peripheral blood alone in 1 (1%) patient. Cumulative incidence of neutrophil engraftment at day 28 was 93.4% (95% confidence interval [CI], 87.3% to 97.1%) while that of platelet engraftment at day 100 was 90.5% (95% CI, 84% to 96%). Cumulative incidence of primary graft failure at day 28 was 6.6% (95% CI, 4% to 8%) while secondary graft failure occurred at a median of 190 days (range, 90 to 415) at a cumulative incidence of 3.7% (95% CI, 2% to 5%). Cumulative incidence of grade II to IV acute GVHD at day 100 was 3.8% (95% CI, 1.4% to 9.9%), while a 1-year probability of chronic GVHD was calculated as 7.5% (95% CI, 2.6% to 15%). Median follow-up post-transplant was 61 months (range, 6 to 144). Overall survival was 84.9%, disease-free survival was 80.2%, and GVHD-free relapse-free survival was 76.3%. This study indicates that single-agent cyclosporine is a feasible option for GVHD prophylaxis in MRD hematopoietic stem cell transplantation using Flu-Cy-ATG conditioning and is associated with very low rates of acute and chronic GVHD.</p></div>","PeriodicalId":9165,"journal":{"name":"Biology of Blood and Marrow Transplantation","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bbmt.2020.07.026","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Biology of Blood and Marrow Transplantation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1083879120304596","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 1

Abstract

Cyclosporine (CsA) combined with short-course methotrexate is considered standard-of-care graft-versus-host disease (GVHD) prophylaxis for patients with severe aplastic anemia (AA) who undergo transplantation using cyclophosphamide (Cy) plus anti-thymocyte globulin (ATG) conditioning. However, there is no consensus on optimal post-transplant GVHD prophylaxis for patients undergoing matched related donor (MRD) transplantation using fludarabine (Flu)-based conditioning. We conducted a single-center retrospective analysis of patients with acquired AA (n = 106) undergoing MRD transplantation from July 2007 through January 2019. All patients received Flu-Cy-ATG conditioning and single-agent CsA as GVHD prophylaxis. Median age of the study cohort was 20 years (range, 3 to 52) and male to female ratio was 3.8:1. Median time from diagnosis to transplant was 11.5 months (range, 2.8 to 62). Graft source was bone marrow harvest in 71 (68%), combined bone marrow and peripheral blood stem cells in 34 (31%), and peripheral blood alone in 1 (1%) patient. Cumulative incidence of neutrophil engraftment at day 28 was 93.4% (95% confidence interval [CI], 87.3% to 97.1%) while that of platelet engraftment at day 100 was 90.5% (95% CI, 84% to 96%). Cumulative incidence of primary graft failure at day 28 was 6.6% (95% CI, 4% to 8%) while secondary graft failure occurred at a median of 190 days (range, 90 to 415) at a cumulative incidence of 3.7% (95% CI, 2% to 5%). Cumulative incidence of grade II to IV acute GVHD at day 100 was 3.8% (95% CI, 1.4% to 9.9%), while a 1-year probability of chronic GVHD was calculated as 7.5% (95% CI, 2.6% to 15%). Median follow-up post-transplant was 61 months (range, 6 to 144). Overall survival was 84.9%, disease-free survival was 80.2%, and GVHD-free relapse-free survival was 76.3%. This study indicates that single-agent cyclosporine is a feasible option for GVHD prophylaxis in MRD hematopoietic stem cell transplantation using Flu-Cy-ATG conditioning and is associated with very low rates of acute and chronic GVHD.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
单药环孢素在接受氟达拉滨为基础的治疗的获得性再生障碍性贫血患者中的移植物抗宿主病预防
环孢素(CsA)联合短期甲氨蝶呤被认为是严重再生障碍性贫血(AA)患者使用环磷酰胺(Cy)加抗胸腺细胞球蛋白(ATG)进行移植的标准治疗移植物抗宿主病(GVHD)预防。然而,对于接受匹配相关供体(MRD)移植的患者使用氟达拉滨(Flu)为基础的调节,移植后GVHD的最佳预防措施尚无共识。我们对2007年7月至2019年1月接受MRD移植的获得性AA患者(n = 106)进行了单中心回顾性分析。所有患者均接受流感- cy - atg调节和单药CsA作为GVHD预防。研究队列的中位年龄为20岁(范围3 - 52岁),男女比例为3.8:1。从诊断到移植的中位时间为11.5个月(范围:2.8 - 62)。移植来源为骨髓71例(68%),骨髓和外周血干细胞联合34例(31%),单独外周血1例(1%)。第28天中性粒细胞植入的累积发生率为93.4%(95%可信区间[CI], 87.3% ~ 97.1%),第100天血小板植入的累积发生率为90.5% (95% CI, 84% ~ 96%)。第28天原发性移植物衰竭的累积发生率为6.6% (95% CI, 4%至8%),而继发性移植物衰竭发生在中位190天(范围,90至415),累积发生率为3.7% (95% CI, 2%至5%)。在第100天,II至IV级急性GVHD的累积发病率为3.8% (95% CI, 1.4%至9.9%),而慢性GVHD的1年概率为7.5% (95% CI, 2.6%至15%)。移植后中位随访时间为61个月(6 ~ 144个月)。总生存率为84.9%,无病生存率为80.2%,无gvhd无复发生存率为76.3%。该研究表明,单药环孢素是使用流感- cy - atg调节的MRD造血干细胞移植中预防GVHD的可行选择,并且与非常低的急性和慢性GVHD发生率相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
期刊最新文献
Table of Contents Editorial Board Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major Early Mixed Lymphoid Donor/Host Chimerism is Associated with Improved Transplant Outcome in Patients with Primary or Secondary Myelofibrosis Real-World Issues and Potential Solutions in Hematopoietic Cell Transplantation during the COVID-19 Pandemic: Perspectives from the Worldwide Network for Blood and Marrow Transplantation and Center for International Blood and Marrow Transplant Research Health Services and International Studies Committee
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1