title: Post-transplant cyclophosphamide, a promising anti-graft versus host disease prophylaxis: where do we stand?
abstract: Post transplant cyclophosphamide (PT/Cy) in association to other immunosuppressive agents or alone has emerged as a promising pharmacological strategy in the setting of allogeneic hematopoietic cell transplant (allo-HCT). Its safety profile and effectiveness in reducing GvHD (acute GvHD incidence comprised between 15 and 30%, chronic GvHD 20-30% in the haploidentical setting) contributed to the spreading of this technique all over the world. Areas covered: This review summarizes the use of PT/Cy in the setting of allo-HCT, both for oncological and non-malignant hematological diseases. Recent studies showed the feasibility of more intense conditioning regimens instead of the original NMAC. The use of peripheral blood stem cells instead of bone marrow as graft source (slightly increase of acute GvHD grade 2 but no differences in survival outcomes) was another significant variation to the original protocol. Later on, PT/Cy alone or in combination with other immunosuppressive agents (ATG, sirolimus, cyclosporine) were tested in the HLA-matched donor setting where lower GvHD rates are reported (acute GvHD grade 3 of 5-10% and chronic GvHD of 10-20%) Expert commentary: The best graft source and type of donor is still ongoing. Moreover, the research of the best pharmacological partner of PT/Cy remains an open question.
authors.affiliation: a Division of Hematology and Bone Marrow Transplant , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mussetti
authors.affiliation: b Hematology and Bone Marrow Transplantation (BMT) Unit , San Raffaele Scientific Institute , Milan , Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Greco
authors.affiliation: b Hematology and Bone Marrow Transplantation (BMT) Unit , San Raffaele Scientific Institute , Milan , Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Peccatori
authors.affiliation: a Division of Hematology and Bone Marrow Transplant , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy.|c Dipartimento di Oncologia ed Emato-oncologia , Universita' degli Studi di Milano , Milan , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
mesh_terms: D000208:Acute Disease; D064591:Allografts; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000379:methods; D006086:Graft vs Host Disease / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020123:Sirolimus / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide; D020123:Sirolimus
keywords: Allogeneic transplant; graft-versus-host disease; haploidentical; matched related donor; post-transplant cyclophosphamide