Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

Rima M Saliba; Amin Alousi Majid; Joseph Pidala; Mukta Arora; Stephen R Spellman; Michael T Hemmer; Tao Wang; Camille Abboud; Sairah Ahmed; Joseph H Antin; Amer Beitinjaneh; David Buchbinder; Michael Byrne; Jean-Yves Cahn; Hannah Choe; Rabi Hanna; Peiman Hematti; Rammurti T Kamble; Carrie L Kitko; Mary Laughlin; Lazaros Lekakis; Margaret L MacMillan; Rodrigo Martino; Parinda A Mehta; Taiga Nishihori; Sagar S Patel; Miguel-Angel Perales; Hemalatha G Rangarajan; Olov Ringdén; Joseph Rosenthal; Bipin N Savani; Kirk R Schultz; Sachiko Seo; Takanori Teshima; Marjolein van der Poel; Leo F Verdonck; Daniel Weisdorf; Baldeep Wirk; Jean A Yared; Jeffrey Schriber; Richard Champlin; Stefan Ciurea

doi:10.1016/j.jtct.2022.07.013

Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

Rima M Saliba^*, Amin Alousi Majid, Joseph Pidala, Mukta Arora, Stephen R Spellman, Michael T Hemmer, Tao Wang, Camille Abboud, Sairah Ahmed, Joseph H Antin, Amer Beitinjaneh, David Buchbinder, Michael Byrne, Jean-Yves Cahn, Hannah Choe, Rabi Hanna, Peiman Hematti, Rammurti T Kamble, Carrie L Kitko, Mary LaughlinLazaros Lekakis, Margaret L MacMillan, Rodrigo Martino, Parinda A Mehta, Taiga Nishihori, Sagar S Patel, Miguel-Angel Perales, Hemalatha G Rangarajan, Olov Ringdén, Joseph Rosenthal, Bipin N Savani, Kirk R Schultz, Sachiko Seo, Takanori Teshima, Marjolein van der Poel, Leo F Verdonck, Daniel Weisdorf, Baldeep Wirk, Jean A Yared, Jeffrey Schriber, Richard Champlin, Stefan Ciurea

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGcHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) within, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.

Original language	English
Pages (from-to)	681-693
Number of pages	13
Journal	Transplantation and Cellular Therapy
Volume	28
Issue number	10
Early online date	16 Jul 2022
DOIs	https://doi.org/10.1016/j.jtct.2022.07.013
Publication status	Published - Oct 2022
Externally published	Yes

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10.1016/j.jtct.2022.07.013Licence: CC BY-NC-ND

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Saliba, R. M., Majid, A. A., Pidala, J., Arora, M., Spellman, S. R., Hemmer, M. T., Wang, T., Abboud, C., Ahmed, S., Antin, J. H., Beitinjaneh, A., Buchbinder, D., Byrne, M., Cahn, J.-Y., Choe, H., Hanna, R., Hematti, P., Kamble, R. T., Kitko, C. L., ... Ciurea, S. (2022). Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis. Transplantation and Cellular Therapy, 28(10), 681-693. https://doi.org/10.1016/j.jtct.2022.07.013

@article{a35800a2188846c09a1196e034be2140,

title = "Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis",

abstract = "Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGcHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) within, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.",

author = "Saliba, {Rima M} and Majid, {Amin Alousi} and Joseph Pidala and Mukta Arora and Spellman, {Stephen R} and Hemmer, {Michael T} and Tao Wang and Camille Abboud and Sairah Ahmed and Antin, {Joseph H} and Amer Beitinjaneh and David Buchbinder and Michael Byrne and Jean-Yves Cahn and Hannah Choe and Rabi Hanna and Peiman Hematti and Kamble, {Rammurti T} and Kitko, {Carrie L} and Mary Laughlin and Lazaros Lekakis and MacMillan, {Margaret L} and Rodrigo Martino and Mehta, {Parinda A} and Taiga Nishihori and Patel, {Sagar S} and Miguel-Angel Perales and Rangarajan, {Hemalatha G} and Olov Ringd{\'e}n and Joseph Rosenthal and Savani, {Bipin N} and Schultz, {Kirk R} and Sachiko Seo and Takanori Teshima and {van der Poel}, Marjolein and Verdonck, {Leo F} and Daniel Weisdorf and Baldeep Wirk and Yared, {Jean A} and Jeffrey Schriber and Richard Champlin and Stefan Ciurea",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = oct,

doi = "10.1016/j.jtct.2022.07.013",

language = "English",

volume = "28",

pages = "681--693",

journal = "Transplantation and Cellular Therapy",

issn = "2666-6375",

publisher = "Elsevier",

number = "10",

}

Saliba, RM, Majid, AA, Pidala, J, Arora, M, Spellman, SR, Hemmer, MT, Wang, T, Abboud, C, Ahmed, S, Antin, JH, Beitinjaneh, A, Buchbinder, D, Byrne, M, Cahn, J-Y, Choe, H, Hanna, R, Hematti, P, Kamble, RT, Kitko, CL, Laughlin, M, Lekakis, L, MacMillan, ML, Martino, R, Mehta, PA, Nishihori, T, Patel, SS, Perales, M-A, Rangarajan, HG, Ringdén, O, Rosenthal, J, Savani, BN, Schultz, KR, Seo, S, Teshima, T, van der Poel, M, Verdonck, LF, Weisdorf, D, Wirk, B, Yared, JA, Schriber, J, Champlin, R & Ciurea, S 2022, 'Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis', Transplantation and Cellular Therapy, vol. 28, no. 10, pp. 681-693. https://doi.org/10.1016/j.jtct.2022.07.013

TY - JOUR

T1 - Characteristics of Graft-Versus-Host Disease (GvHD) After Post-Transplantation Cyclophosphamide Versus Conventional GvHD Prophylaxis

AU - Saliba, Rima M

AU - Majid, Amin Alousi

AU - Pidala, Joseph

AU - Arora, Mukta

AU - Spellman, Stephen R

AU - Hemmer, Michael T

AU - Wang, Tao

AU - Abboud, Camille

AU - Ahmed, Sairah

AU - Antin, Joseph H

AU - Beitinjaneh, Amer

AU - Buchbinder, David

AU - Byrne, Michael

AU - Cahn, Jean-Yves

AU - Choe, Hannah

AU - Hanna, Rabi

AU - Hematti, Peiman

AU - Kamble, Rammurti T

AU - Kitko, Carrie L

AU - Laughlin, Mary

AU - Lekakis, Lazaros

AU - MacMillan, Margaret L

AU - Martino, Rodrigo

AU - Mehta, Parinda A

AU - Nishihori, Taiga

AU - Patel, Sagar S

AU - Perales, Miguel-Angel

AU - Rangarajan, Hemalatha G

AU - Ringdén, Olov

AU - Rosenthal, Joseph

AU - Savani, Bipin N

AU - Schultz, Kirk R

AU - Seo, Sachiko

AU - Teshima, Takanori

AU - van der Poel, Marjolein

AU - Verdonck, Leo F

AU - Weisdorf, Daniel

AU - Wirk, Baldeep

AU - Yared, Jean A

AU - Schriber, Jeffrey

AU - Champlin, Richard

AU - Ciurea, Stefan

PY - 2022/10

Y1 - 2022/10

N2 - Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGcHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) within, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.

AB - Post-transplantation cyclophosphamide (PTCy) has been shown to effectively control graft-versus-host disease (GvHD) in haploidentical (Haplo) transplantations. In this retrospective registry study, we compared GvHD organ distribution, severity, and outcomes in patients with GvHD occurring after Haplo transplantation with PTCy GvHD prophylaxis (Haplo/PTCy) versus HLA-matched unrelated donor transplantation with conventional prophylaxis (MUD/conventional). We evaluated 2 cohorts: patients with grade 2 to 4 acute GvHD (aGvHD) including 264 and 1163 recipients of Haplo and MUD transplants; and patients with any chronic GvHD (cGvHD) including 206 and 1018 recipients of Haplo and MUD transplants, respectively. In comparison with MUD/conventional transplantation ± antithymocyte globulin (ATG), grade 3-4 aGvHD (28% versus 39%, P = .001), stage 3-4 lower gastrointestinal (GI) tract aGvHD (14% versus 21%, P = .01), and chronic GI GvHD (21% versus 31%, P = .006) were less common after Haplo/PTCy transplantation. In patients with grade 2-4 aGvHD, cGcHD rate after Haplo/PTCY was also lower (hazard ratio [HR] = .4, P < .001) in comparison with MUD/conventional transplantation without ATG in the nonmyeloablative conditioning setting. Irrespective of the use of ATG, non-relapse mortality rate was lower (HR = .6, P = .01) after Haplo/PTCy transplantation, except for transplants that were from a female donor into a male recipient. In patients with cGvHD, irrespective of ATG use, Haplo/PTCy transplantation had lower non-relapse mortality rates (HR = .6, P = .04). Mortality rate was higher (HR = 1.6, P = .03) within, but not after (HR = .9, P = .6) the first 6 months after cGvHD diagnosis. Our results suggest that PTCy-based GvHD prophylaxis mitigates the development of GI GvHD and may translate into lower GvHD-related non-relapse mortality rate.

U2 - 10.1016/j.jtct.2022.07.013

DO - 10.1016/j.jtct.2022.07.013

M3 - Article

C2 - 35853610

SN - 2666-6375

VL - 28

SP - 681

EP - 693

JO - Transplantation and Cellular Therapy

JF - Transplantation and Cellular Therapy

IS - 10

ER -