title: Post-transplant high-dose cyclophosphamide after HLA-matched vs haploidentical hematopoietic cell transplantation for AML.
abstract: Post-transplant cyclophosphamide (PT-Cy) is the backbone of GvHD prophylaxis following haploidentical hematopoietic cell transplantation (haplo-HCT). PT-Cy has also been used in matched related (MRD) and unrelated (MUD) settings. It is not known whether outcomes are similar between haplo-HCT and MRD/MUD HCT when PT-Cy is used. We performed a retrospective analysis of 83 patients with AML who underwent HCT (using PT-Cy-based GvHD prophylaxis) from MRD, MUD or haploidentical donors. The groups were similar in baseline characteristics with the exception of older age in the MRD/MUD group (P=0.012). In multivariate analysis, the effect of donor type (MRD/MUD vs haploidentical) on transplant outcomes was not significant in any of the models except for faster neutrophil recovery after MRD/MUD transplants (hazard ratio: 2.21; 95% confidence interval: 1.31-3.72, P=0.002). In conclusion, we showed similar outcomes in MRD/MUD vs haploidentical HCT (except slower count recovery following haplo-HCT) when PT-Cy is used for GvHD prophylaxis. Although slower count recovery following haplo-HCT (compared with MRD/MUD transplants without PT-Cy) has been attributed to using PT-Cy, our results suggest that HLA disparity is the primary cause of this difference. Furthermore, our analysis supports PT-Cy as a viable option for GvHD prophylaxis after MRD/MUD transplants.
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-9384-272X
authors.initials: A
authors.lastname: Rashidi
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-8092-6644
authors.initials: M
authors.lastname: Slade
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: DiPersio
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: P
authors.initials: P
authors.lastname: Westervelt
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: R
authors.initials: R
authors.lastname: Vij
authors.affiliation: Bone Marrow Transplantation and Leukemia Section, Division of Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: R
authors.initials: R
authors.lastname: Romee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors; D003520:Cyclophosphamide / Q000008:administration & dosage*; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide