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Graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide in chronic myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation from an unrelated or mismatched related donor : a comparative study from the chronic malignancies working party of the EBMT (CMWP-EBMT)

Published inTransplantation and cellular therapy, vol. 30, no. 1, p. 93.e1-93.e12
Publication date2024-01
First online date2023-09-30
Abstract

Outcomes following allogeneic hematopoietic cell transplantation (allo-HCT) for chronic myeloid leukemia (CML) with post-transplantation cyclophosphamide (PTCy) using an unrelated donor (UD) or a mismatched related donor (MMRD) remain unknown. We report a retrospective comparison of PTCy-based allo-HCT from a UD, non-PTCy allo-HCT from a UD, and PTCy allo-HCT from an MMRD. Inclusion criteria were adult patients with CML undergoing first allo-HCT between 2012 and 2019 from a UD with either PTCy or non-PTCy graft-versus-host disease (GVHD) prophylaxis or from an MMRD using PTCy. The primary endpoint was GVHD-free/relapse-free survival (GRFS). A total of 1341 patients were included (82% in the non-PTCy UD cohort). With a median follow-up of 34.9 months, the 3-year GRFS was 43% in the non-PTCy cohort, 37% in the PTCy-UD cohort, and 39% PTCy-MMRD cohort (P = .15). Multivariable analyses revealed no significant differences among the 3 cohorts in terms of overall survival (OS), progression-free survival, RI, and nonrelapse mortality. Factors independently associated with worse OS in the overall cohort were Karnofsky Performance Status <90 (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.41 to 2.45; P < .001), older age (HR, 1.24, 95% CI, 1.11 to 1.38; P < .001), and disease stage (compared to chronic phase [CP] 1): blast phase (HR, 2.25; 95% CI, 1.60 to 3.16; P < .001), accelerated phase (HR, 1.63; 95% CI, 1.05 to 2.54; P = .03), and CP >2 (HR, 1.58; 95% CI, 1.15 to 2.17; P = .005). These results suggest that allo-HCT in patients with CML using either a UD or an MMRD with PTCy-based GVHD prophylaxis are feasible transplantation, platforms and that the disease stage at allo-HCT remains a major prognostic factor, highlighting the importance of closely monitoring CML patients and proposing transplantation when indicated when still in CP1.

Keywords
  • Allogeneic hematopoietic cell transplantation
  • Chronic myeloid leukemia
  • Haploidentical donor
  • Post-transplantation cyclophosphamide
  • Unrelated donor
  • Adult
  • Humans
  • Chronic Disease
  • Cyclophosphamide / therapeutic use
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy
  • Leukemia, Myeloid
  • Retrospective Studies
  • Unrelated Donors
Citation (ISO format)
ORTÍ, Guillermo et al. Graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide in chronic myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation from an unrelated or mismatched related donor : a comparative study from the chronic malignancies working party of the EBMT (CMWP-EBMT). In: Transplantation and cellular therapy, 2024, vol. 30, n° 1, p. 93.e1–93.e12. doi: 10.1016/j.jtct.2023.09.019
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ISSN of the journal2666-6367
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