Post-transplant Cyclophosphamide is a Valid Option for GVHD Prophylaxis in Both HLA-matched and Mismatched Allogeneic Transplants

Abstract

Despite improvement in transplantation techniques and supportive care, graft versus host disease (GVHD) remains a major cause of post-transplant morbidity and mortality. Advances in immunosuppressive regimens have reduced the incidence and severity of acute GVHD; with no such impact on chronic GVHD. In addition to the considerable toxicity of calcineurin inhibitors (CNI)-based regimens [1]. We compared the safety and efficacy of post allogeneic transplant cyclophosphamide as GVHD prophylaxis versus CNI prophylaxis. This study included 63 patients (2 groups) admitted to Hematology unit, Maadi Armed Forces Medical Compound, Cairo for allogeneic stem cell transplantation for hematological malignancies. Group I received post-transplant cyclophosphamide prophylaxis (50 mg /kg/day), while group II received CNI based prophylaxis. Patients were followed for 6 months for acute and chronic GVHD, infections, and drug toxicities. Most patients successfully underwent hematopoietic reconstitution with no significant difference between both groups in time to hematological recovery. Hepatic and renal toxicities were more common in group II than group I (78.6% vs. 30.8%, P=0.002) and (60% vs. 20.5%, P=0.022) respectively. No significant difference between both groups in the incidence of CMV reactivation or acute and chronic GVHD. Disease free survival and overall survival were not significantly different between both groups either in matched or mismatched transplants, with a trend for better survival in group I than group II (4 vs. 1.4 months, P=0.087). We concluded that post-transplant cyclophosphamide for GVHD prophylaxis is safe, effective and valid option in allogeneic stem cell transplantation, with a different toxicity profile compared with CNI regimens [2].