Post-Transplant Cyclophosphamide versus Anti-Thymocyte Globulin in Patients with Hematological Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Haploidentical and Matched Unrelated Donors: A Real-Life Experience
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | PTCY Cohort | ATG Cohort | p Value |
---|---|---|---|
n = 24 | n= 16 | ||
Median age, years (range) | 51 (20–71) | 45 (21–61) | 0.39 |
Gender, n (%) | 0.25 | ||
Male | 11 (46) | 5 (31) | |
Female | 13 (54) | 11 (69) | |
Hematologic malignancy, n (%) | 0.63 | ||
AML | 15 (63) | 12 (75) | |
ALL | 5 (21) | 4 (25) | |
MM | 3 (12) | - | |
Other | 1 (4) | - | |
Stem cell source, n (%) | 0.05 | ||
Peripheral blood | 11 (46) | 12 (75) | |
Bone marrow | 13 (54) | 4 (25) | |
Time to transplant, months, median (range) | 11 (1–35) | 9 (1–44) | 0.23 |
Stem cells infused, ×106/kg, median (range) | 3.70 (0.60–7.90) | 4.78 (1–8.29) | 0.05 |
Type of donor, n (%) | 0.001 | ||
Sister/brother | 7 (30) | 13 (72) | |
Mother/father | 2 (8) | 2 (12) | |
Son/daughter | 13 (54) | 1 (6) | |
MUD | 2 (8) | - | |
CMV serostatus, n (%) | 0.5 | ||
R+/D+ | 17 (71) | 12 (75) | |
R−/D+ | 3 (13) | 2 (12) | |
R+/D− | 2 (8) | 1 (6) | |
R−/D− | 2 (8) | 1 (6) | |
Conditioning regimen, n (%) | 0.001 | ||
TBF | 22 (92) | 5 (31) | |
BU-FLU | 1 (4) | 9 (56) | |
FLU-MEL | 1 (4) | - | |
R-TBF | - | 2 (13) | |
Type of conditioning, n (%) | 0.07 | ||
Myeloablative | 17 (71) | 15 (94) | |
Reduced intensity | 7 (29) | 1 (6) | |
Immunosuppressive drugs, n (%) | 0.001 | ||
CSA + MTX | - | 10 (63) | |
CSA + tacrolimus | - | 6 (37) | |
CSA + MMF | 24 (100) | - | |
Engraftment failure, n (%) | 2 (8) | 3 (19) | 0.32 |
Neutrophil engraftment, days, median (range) | 20 (11–36) | 16 (10–25) | 0.01 |
Platelet engraftment, days, median (range) | 29 (11–184) | 16 (10–37) | 0.03 |
Acute GvHD, sites, n (%) | 11 (46) | 6 (37) | 0.72 |
Skin | 8 (32) | 4 (25) | |
Intestine | 6 (24) | 1 (6) | |
Liver | 4 (16) | 2 (13) | |
Acute GvHD grading, n (%) | 0.8 | ||
Grade I–II | 10 (40) | 5 (31) | |
Grade III–IV | 1 (4) | 1 (6) | |
Chronic GvHD, sites, n (%) | 10 (42) | 5 (31) | 0.8 |
Skin | 7 (28) | 5 (31) | |
Intestine | 2 (8) | 2 (13) | |
Liver | 4 (16) | 1 (6) | |
Lung | 1 (4) | 1 (6) | |
Eyes | 1 (4) | - | |
Chronic GvHD grading, n (%) | 0.7 | ||
Mild | 6 (24) | 3 (19) | |
Severe | 4 (16) | 2 (13) | |
Donor lymphocyte infusion, n (%) | 3 (12) | 2 (13) | 0.97 |
Hematological relapse, n (%) | 4 (16) | 8 (50) | 0.02 |
All-cause deaths, n (%) | 9 (36) | 12 (75) | 0.02 |
Causes of death, n (%) | 0.03 | ||
Relapse | 3 (13) | 8 (50) | |
GvHD | 3 (13) | 1(6) | |
Infections | 3 (13) | 1(6) | |
Others | - | 2 (12) | |
Transplant-related mortality, n (%) | 4 (17) | 4 (25) | 0.56 |
2-year relapse-free survival | 80% | 51% | 0.04 |
2-year overall survival | 61% | 42% | 0.26 |
Dependent Variable = GvHD Occurrence | OR | 95%CI | p Value |
---|---|---|---|
PTCY [yes] | 1.27 | 0.34–4.69 | 0.72 |
Gender [female] | 1.52 | 0.41–5.61 | 0.52 |
Age, years | 0.96 | 0.91–1.01 | 0.12 |
Bone marrow HSCs | 0.21 | 0.05–0.86 | 0.03 |
Number of infused HSCs | 1.36 | 0.95–1.96 | 0.09 |
Donor type [sister/brother] | 1.71 | 0.47–6.16 | 0.40 |
RIC | 1.37 | 0.27–6.67 | 0.69 |
Conditioning with TBF | 0.9 | 0.5–2.45 | 0.8 |
Dependent Variable = Relapse | OR | 95%CI | p Value |
PTCY [yes] | 0.2 | 0.04–0.85 | 0.03 |
Gender [female] | 0.9 | 0.22–3.58 | 0.88 |
Age, years | 0.98 | 0.93–1.03 | 0.57 |
Bone marrow HSCs | 0.57 | 0.14–2.36 | 0.44 |
Number of infused HSCs | 1.21 | 0.86–1.70 | 0.27 |
Donor type [sister/brother] | 2.6 | 0.64–10.9 | 0.17 |
RIC | 1.34 | 0.23–7.97 | 0.73 |
Conditioning with TBF | 0.7 | 0.4–2 | 0.5 |
Dependent Variable = Neutrophil Engraftment | β | 95%CI | p Value |
Gender [female] | −0.3 | −4.54/3.82 | 0.86 |
Age, years | −0.1 | −0.24/0.04 | 0.17 |
PTCY [yes] | 5 | 1.23/8.81 | 0.01 |
Bone marrow HSCs | 5.23 | 1.59/8.88 | 0.01 |
Number of infused HSCs | −0.8 | −1.8/0.15 | 0.09 |
Donor type [sister/brother] | −1 | −5.1/3.02 | 0.61 |
RIC | 0.24 | −4.73/5.22 | 0.1 |
Dependent Variable = Platelet Engraftment | β | 95%CI | p Value |
Gender [female] | 3.7 | −17.9/25.3 | 0.72 |
Age, years | 0.32 | −0.44/1.09 | 0.4 |
PTCY [yes] | 17 | 0.5/35 | 0.04 |
Bone marrow HSCs | 16.1 | −3.7/34 | 0.1 |
Number of infused HSCs | −5.1 | −10.3/−0.01 | 0.09 |
Donor type [sister/brother] | −0.2 | −4.1/2.04 | 0.57 |
RIC | 3.67 | −24.4/31.8 | 0.89 |
Dependent Variable = GvHD Occurrence | OR | 95%CI | p Value |
---|---|---|---|
Age, years | 0.95 | 0.62–1.91 | 0.16 |
Bone marrow HSCs | 0.29 | 0.03–2.75 | 0.28 |
Number of infused HSCs | 1.09 | 0.62–1.91 | 0.74 |
Dependent Variable = Relapse | OR | 95%CI | p Value |
PTCY [yes] | 0.08 | 0.01–0.89 | 0.03 |
Age, years | 0.98 | 0.92–1.05 | 0.72 |
Number of infused HSCs | 1.1 | 0.72–1.66 | 0.65 |
Donor type [sister/brother] | 2.03 | 0.59–6.98 | 0.25 |
Dependent Variable = Neutrophil Engraftment | β | 95%CI | p Value |
Age, years | −0.1 | −0.2/0.01 | 0.07 |
PTCY [yes] | 4 | 0.5/7.70 | 0.03 |
Bone marrow HSCs | 4.1 | 0.67–7.69 | 0.02 |
Dependent Variable = Platelet Engraftment | β | 95%CI | p Value |
Age, years | 0.26 | −0.47/1.01 | 0.47 |
PTCY [yes] | 4 | −5.65/36.8 | 0.14 |
Bone marrow HSCs | 11.9 | −9.06/32 | 0.25 |
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Serio, B.; Storti, G.; D’Addona, M.; Santoro, L.; Frieri, C.; De Novellis, D.; Marano, L.; De Santis, G.; Guariglia, R.; Manfra, I.; et al. Post-Transplant Cyclophosphamide versus Anti-Thymocyte Globulin in Patients with Hematological Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Haploidentical and Matched Unrelated Donors: A Real-Life Experience. Hematol. Rep. 2024, 16, 234-243. https://doi.org/10.3390/hematolrep16020023
Serio B, Storti G, D’Addona M, Santoro L, Frieri C, De Novellis D, Marano L, De Santis G, Guariglia R, Manfra I, et al. Post-Transplant Cyclophosphamide versus Anti-Thymocyte Globulin in Patients with Hematological Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Haploidentical and Matched Unrelated Donors: A Real-Life Experience. Hematology Reports. 2024; 16(2):234-243. https://doi.org/10.3390/hematolrep16020023
Chicago/Turabian StyleSerio, Bianca, Gabriella Storti, Matteo D’Addona, Lidia Santoro, Camilla Frieri, Danilo De Novellis, Luana Marano, Giovanna De Santis, Roberto Guariglia, Ilenia Manfra, and et al. 2024. "Post-Transplant Cyclophosphamide versus Anti-Thymocyte Globulin in Patients with Hematological Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Haploidentical and Matched Unrelated Donors: A Real-Life Experience" Hematology Reports 16, no. 2: 234-243. https://doi.org/10.3390/hematolrep16020023