Abstract
Graft-versus-host disease (GVHD) represents a major contributor to morbidity and mortality in recipients of allogeneic hematopoietic cell transplants (HCT). Several strategies exist for GVHD prophylaxis and include post-transplant cyclophosphamide (PTCY) and anti-thymocyte globulin (ATG). While several groups have described the use of PTCY in younger patients, there is a paucity of data about the efficacy of PTCY in older individuals, particularly when combined with ATG. We investigated the effect of PTCY and ATG combination on transplant outcomes in older patients at Princess Margaret Cancer Centre, Toronto, Canada. Compared to those patients who received other forms of GVHD prophylaxis, individuals who received ATG-PTCY combination had higher 2-year overall survival (OS), 57% (95% confidence interval, 44–69) vs 37% (26–49), P = 0.02; higher 2-year graft-vs-host– and relapse-free survival (GRFS), 27% (17–39) vs 12% (6–21), P = 0.01; lower 2-year non-relapse mortality (NRM), 21% (12–32) vs 45% (33–56), P = 1.00 × 10−3; lower 100-day incidence of grade 2–4 acute GVHD (aGVHD), 11% (5–21) vs 28% (18–39), P = 0.02; and lower 100-day incidence of grade 3–4 aGVHD, 0% vs 7% (3–15), P = 0.02 without an increase in the 2-year cumulative incidence of relapse (CIR), 31% (20–43) vs 21% (12–32), P = 0.14. Therefore, in older HCT recipients, use of PTCY combined with ATG is associated with improved OS, lower NRM, decreased risk of aGVHD, and improved GRFS without a significant increase in relapse risk. Therefore, the PTCY with ATG combination represents an effective strategy for GVHD prophylaxis in older allogeneic HCT recipients.
Similar content being viewed by others
References
Lee SJ (2016) Classification systems for chronic graft-versus-host disease. Blood 129:30–37. https://doi.org/10.1182/blood-2016-07-686642
Zeiser R, Blazar BR (2017) Acute graft-versus-host disease - biologic process, prevention, and therapy. New Engl J Med 377:2167–2179. https://doi.org/10.1056/nejmra1609337
Jagasia MH, Greinix HT, Arora M et al (2014) National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 21:389–401.e1. https://doi.org/10.1016/j.bbmt.2014.12.001
MacDonald KP, Betts BC, Couriel D (2018) Emerging therapeutics for the control of chronic graft-versus-host disease. Biol Blood Marrow Tr 24:19–26. https://doi.org/10.1016/j.bbmt.2017.10.006
Sarantopoulos S, Cardones AR, Llivan K (2019) How I treat refractory chronic graft-versus-host disease. Blood 133:1191–1200. https://doi.org/10.1182/blood-2018-04-785899
Ghalie R et al (1988) Cyclosporine and graft-versus-host disease after bone marrow transplantation. New Engl J Med 319:1607–1608. https://doi.org/10.1056/nejm198812153192414
Bianchi M, Heim D, Lengerke C et al (2018) Cyclosporine levels > 195 μg/L on day 10 post-transplant was associated with significantly reduced acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. Ann Hematol 98:971–977. https://doi.org/10.1007/s00277-018-3577-1
Chhabra S, Liu Y, Hemmer MT et al (2018) Comparative analysis of calcineurin inhibitor-based methotrexate and mycophenolate mofetil-containing regimens for prevention of graft-versus-host disease after reduced-intensity conditioning allogeneic transplantation. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 25:73–85. https://doi.org/10.1016/j.bbmt.2018.08.018
de Kort EA, de Lil HS, Bremmers ME et al (2019) Cyclosporine a trough concentrations are associated with acute GvHD after non-myeloablative allogeneic hematopoietic cell transplantation. PLoS One 14:e0213913. https://doi.org/10.1371/journal.pone.0213913
Deeg H, Storb R, Thomas E et al (1985) Cyclosporine as prophylaxis for graft-versus-host disease: a randomized study in patients undergoing marrow transplantation for acute nonlymphoblastic leukemia. Blood 65:1325–1334. https://doi.org/10.1182/blood.v65.6.1325.bloodjournal6561325
Stocker N, Duléry R, Battipaglia G et al (2019) Impact of cyclosporine a concentration on acute graft-vs-host disease incidence after haploidentical hematopoietic cell transplantation. Eur J Haematol 103:10–17. https://doi.org/10.1111/ejh.13233
Bolaños-Meade J, Reshef R, Fraser R et al (2019) Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol 6:e132–e143. https://doi.org/10.1016/s2352-3026(18)30221-7
Fay J, Wingard J, Antin J et al (1996) FK506 (Tacrolimus) monotherapy for prevention of graft-versus-host disease after histocompatible sibling allogenic bone marrow transplantation. Blood 87:3514–3519. https://doi.org/10.1182/blood.v87.8.3514.bloodjournal8783514
Nash R, Etzioni R, Storb R et al (1995) Tacrolimus (FK506) alone or in combination with methotrexate or methylprednisolone for the prevention of acute graft-versus-host disease after marrow transplantation from HLA-matched siblings: a single-center study. Blood 85:3746–3753. https://doi.org/10.1182/blood.v85.12.3746.bloodjournal85123746
Shah M, Liba R, Rondon G et al (2018) Pilot study using post-transplant cyclophosphamide (PTCy), tacrolimus and mycophenolate GVHD prophylaxis for older patients receiving 10/10 HLA-matched unrelated donor hematopoietic stem cell transplantation. Bone Marrow Transplant 54:601–606. https://doi.org/10.1038/s41409-018-0367-2
Salhotra A, Mei M, Stiller T et al (2018) Outcomes of patients with recurrent and refractory lymphoma undergoing allogeneic hematopoietic cell transplantation with BEAM conditioning and sirolimus- and tacrolimus-based GVHD prophylaxis. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 25:287–292. https://doi.org/10.1016/j.bbmt.2018.09.009
Antin JH, Kim HT, Cutler C et al (2003) Sirolimus, tacrolimus, and low-dose methotrexate for graft-versus-host disease prophylaxis in mismatched related donor or unrelated donor transplantation. Blood 102:1601–1605. https://doi.org/10.1182/blood-2003-02-0489
Benito AI, Furlong T, Martin PJ et al (2001) Sirolimus (rapamycin) for the treatment of steroid-refractory acute graft-versus-host disease. Transplantation 72:1924–1929. https://doi.org/10.1097/00007890-200112270-00010
Carpenter PA, Logan BR, Lee SJ et al (2018) A phase II/III randomized, multicenter trial of prednisone/sirolimus versus prednisone/ sirolimus/calcineurin inhibitor for the treatment of chronic graft- versus -host disease: BMT CTN 0801. Haematologica 103:1915–1924. https://doi.org/10.3324/haematol.2018.195123
Kim T, DeVeaux M, Stahl M et al (2018) Long-term follow-up of a single institution pilot study of sirolimus, tacrolimus, and short course methotrexate for graft versus host disease prophylaxis in mismatched unrelated donor allogeneic stem cell transplantation. Ann Hematol 98:237–240. https://doi.org/10.1007/s00277-018-3427-1
Adachi Y, Ozeki K, Ukai S et al (2019) Optimal dosage of methotrexate for GVHD prophylaxis in umbilical cord blood transplantation. Int J Hematol 109:440–450. https://doi.org/10.1007/s12185-019-02598-x
Filipovich A, Krawczak C, Kersey J et al (1985) Graft-versus-host disease prophylaxis with anti-T-cell monoclonal antibody OKT3, prednisone and methotrexate in allogeneic bone-marrow transplantation. Brit J Haematol 60:143–152. https://doi.org/10.1111/j.1365-2141.1985.tb07395.x
Lazarus H, Coccia P, Herzig R et al (1984) Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. Blood 64:215–220. https://doi.org/10.1182/blood.v64.1.215.215
Kawashima N, Iida M, Suzuki R et al (2019) Prophylaxis and treatment with mycophenolate mofetil in children with graft-versus-host disease undergoing allogeneic hematopoietic stem cell transplantation: a nationwide survey in Japan. Int J Hematol 109:491–498. https://doi.org/10.1007/s12185-019-02601-5
Ruutu T, Volin L, Parkkali T et al (2000) Cyclosporine, methotrexate, and methylprednisolone compared with cyclosporine and methotrexate for the prevention of graft-versus-host disease in bone marrow transplantation from HLA-identical sibling donor: a prospective randomized study. Blood 96:2391–2398. https://doi.org/10.1182/blood.v96.7.2391
Delgado J, Pillai N, Benjamin R et al (2008) The effect of in vivo T cell depletion with alemtuzumab on reduced-intensity allogeneic hematopoietic cell transplantation for chronic lymphocytic leukemia. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 14:1288–1297. https://doi.org/10.1016/j.bbmt.2008.09.001
Hamad N, Bel R, Messner HA et al (2014) Outcomes of hematopoietic cell transplantation in adult patients with acquired aplastic anemia using intermediate-dose alemtuzumab-based conditioning. Biol Blood Marrow Tr 20:1722–1728. https://doi.org/10.1016/j.bbmt.2014.06.033
Ho AY, Pagliuca A, Kenyon M et al (2004) Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning. Blood 104:1616–1623. https://doi.org/10.1182/blood-2003-12-4207
Potter VT, Krishnamurthy P, Barber LD et al (2013) Long-term outcomes of alemtuzumab-based reduced-intensity conditioned hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myelogenous leukemia secondary to myelodysplastic syndrome. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 20:111–117. https://doi.org/10.1016/j.bbmt.2013.10.021
Brodsky R, Luznik L, Bolaños-Meade J et al (2008) Reduced intensity HLA-haploidentical BMT with post transplantation cyclophosphamide in nonmalignant hematologic diseases. Bone Marrow Transplant 42:523–527. https://doi.org/10.1038/bmt.2008.203
Kanakry CG, O’Donnell PV, Furlong T et al (2014) Multi-institutional study of post-transplantation cyclophosphamide as single-agent graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation using myeloablative busulfan and fludarabine conditioning. J Clin Oncol Off J Am Soc Clin Oncol 32:3497–3505. https://doi.org/10.1200/jco.2013.54.0625
Pagliardini T, Castagna L, Harbi S et al (2019) Thiotepa, fludarabine and busulfan conditioning regimen before t-cell replete haploidentical transplantation with post-transplant cyclophosphamide for acute myeloid leukemia: a bicentric experience of 100 patients. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 25:1803–1809. https://doi.org/10.1016/j.bbmt.2019.05.014
Bashey A, Zhang M-J, McCurdy SR et al (2017) Mobilized peripheral blood stem cells versus Unstimulated bone marrow as a graft source for T-cell–replete haploidentical donor transplantation using post-transplant cyclophosphamide. J Clin Oncol 35. https://doi.org/10.1200/jco.2017.72.8428
Vine S (2017) Haploidentical hematopoietic cell transplantation using post-transplantation cyclophosphamide: does graft source matter? J Clin Oncol Off J Am Soc Clin Oncol 35:2984–2986. https://doi.org/10.1200/jco.2017.73.7775
Bashey A, Zhang X, Sizemore CA et al (2013) T-cell–replete HLA-haploidentical hematopoietic transplantation for hematologic malignancies using post-transplantation cyclophosphamide results in outcomes equivalent to those of contemporaneous HLA-matched related and unrelated donor transplantation. J Clin Oncol 31:1310–1316. https://doi.org/10.1200/jco.2012.44.3523
Kasamon YL, Bolaños-Meade J, Prince GT et al (2015) Outcomes of nonmyeloablative HLA-haploidentical blood or marrow transplantation with high-dose post-transplantation cyclophosphamide in older adults. J Clin Oncol Off J Am Soc Clin Oncol 33:3152–3161. https://doi.org/10.1200/jco.2014.60.4777
Martínez C, Gayoso J, Canals C et al (2017) Post-transplantation cyclophosphamide-based haploidentical transplantation as alternative to matched sibling or unrelated donor transplantation for Hodgkin lymphoma: a registry study of the lymphoma working Party of the European Society for blood and marrow transplantation. J Clin Oncol 35. https://doi.org/10.1200/jco.2017.72.6869
Rimondo A, Crocchiolo R, El-Cheikh J et al (2016) The calcineurin inhibitor and the intensity of the conditioning regimen may affect the occurrence of polyomavirus-associated hemorrhagic cystitis after haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 52:135–137. https://doi.org/10.1038/bmt.2016.193
Carnevale-Schianca F, Caravelli D, Gallo S et al (2017) Post-transplant cyclophosphamide and tacrolimus–mycophenolate mofetil combination prevents graft-versus-host disease in allogeneic peripheral blood hematopoietic cell transplantation from HLA-matched donors. Biol Blood Marrow Tr 23:459–466. https://doi.org/10.1016/j.bbmt.2016.12.636
Moiseev IS, Pirogova OV, Alyanski AL et al (2016) Graft-versus-host disease prophylaxis in unrelated peripheral blood stem cell transplantation with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Biol Blood Marrow Tr 22:1037–1042. https://doi.org/10.1016/j.bbmt.2016.03.004
Cieri N, Greco R, Crucitti L et al (2015) Post-transplantation cyclophosphamide and sirolimus after haploidentical hematopoietic stem cell transplantation using a treosulfan-based myeloablative conditioning and peripheral blood stem cells. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 21:1506–1514. https://doi.org/10.1016/j.bbmt.2015.04.025
Greco R, Lorentino F, Morelli M et al (2016) Posttransplantation cyclophosphamide and sirolimus for prevention of GVHD after HLA-matched PBSC transplantation. Blood 128:1528–1531. https://doi.org/10.1182/blood-2016-06-723205
Jaiswal S, Chatterjee S, Mukherjee S et al (2015) Pre-transplant sirolimus might improve the outcome of haploidentical peripheral blood stem cell transplantation with post-transplant cyclophosphamide for patients with severe aplastic anemia. Bone Marrow Transplant 50:873–875. https://doi.org/10.1038/bmt.2015.50
Jaiswal S, Bhakuni P, Zaman S et al (2017) T cell costimulation blockade promotes transplantation tolerance in combination with sirolimus and post-transplantation cyclophosphamide for haploidentical transplantation in children with severe aplastic anemia. Transpl Immunol 43–44:54–59. https://doi.org/10.1016/j.trim.2017.07.004
Solomon SR, Sanacore M, Zhang X et al (2014) Calcineurin inhibitor--free graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide and brief-course sirolimus following reduced-intensity peripheral blood stem cell transplantation. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 20:1828–1834. https://doi.org/10.1016/j.bbmt.2014.07.020
Deotare U, Atenafu EG, Loach D et al (2017) Reduction of severe acute graft-versus-host disease using a combination of pre transplant anti-thymocyte globulin and post-transplant cyclophosphamide in matched unrelated donor transplantation. Bone Marrow Transplant 53:361–365. https://doi.org/10.1038/s41409-017-0053-9
Law A, Salas M, Lam W et al (2018) Reduced intensity conditioning and dual T-lymphocyte suppression with anti-thymocyte globulin and post-transplant cyclophosphamide as graft versus host disease prophylaxis in haploidentical stem cell transplants for hematological malignancies. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 24:2259–2264. https://doi.org/10.1016/j.bbmt.2018.07.008
Prem S, Atenafu EG, Al-Shaibani Z et al (2019) Low rates of acute and chronic GVHD with ATG and PTCy in matched and mismatched unrelated donor peripheral blood stem cell transplants. Eur J Haematol 102:486–493. https://doi.org/10.1111/ejh.13230
Wang Y, Wu D-P, Liu Q-F et al (2019) Low-dose post-transplant cyclophosphamide and anti-thymocyte globulin as an effective strategy for GVHD prevention in haploidentical patients. J Hematol Oncol 12:88. https://doi.org/10.1186/s13045-019-0781-y
Lazaryan A, Weisdorf DJ, DeFor T et al (2015) Risk factors for acute and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation with umbilical cord blood and matched sibling donors. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 22:134–140. https://doi.org/10.1016/j.bbmt.2015.09.008
Kyriakou C, Boumendil A, Finel H et al (2018) The impact of advanced patient age on mortality after allogeneic hematopoietic cell transplantation for non-Hodgkin lymphoma: a retrospective study by the European Society for Blood and Marrow Transplantation Lymphoma Working Party. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 25:86–93. https://doi.org/10.1016/j.bbmt.2018.08.025
Sorror ML (2013) How I assess comorbidities before hematopoietic cell transplantation. Blood 121:2854–2863. https://doi.org/10.1182/blood-2012-09-455063
Ruggeri A, Sun Y, Labopin M et al (2016) Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus -host disease prophylaxis in haploidentical transplant. Haematologica 102:401–410. https://doi.org/10.3324/haematol.2016.151779
Kanda Y (2012) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244
Ashizawa M, Akahoshi Y, Nakano H et al (2014) A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. Int J Hematol 99:311–317. https://doi.org/10.1007/s12185-014-1501-6
Pasic I, Da’na W, Lam W et al (2019) Influence of FLT3-ITD and NPM1 status on allogeneic hematopoietic cell transplant outcomes in patients with cytogenetically normal AML. Eur J Haematol 102:368–374. https://doi.org/10.1111/ejh.13216
Bashey ZA, Zhang X, Brown S et al (2018) Comparison of outcomes following transplantation with T-replete HLA-haploidentical donors using post-transplant cyclophosphamide to matched related and unrelated donors for patients with AML and MDS aged 60 years or older. Bone Marrow Transplant 53:756–763. https://doi.org/10.1038/s41409-018-0126-4
Blaise D, Fürst S, Crocchiolo R et al (2015) Haploidentical T cell-replete transplantation with post-transplantation cyclophosphamide for patients in or above the sixth decade of age compared with allogeneic hematopoietic stem cell transplantation from an human leukocyte antigen-matched related or unrelated donor. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 22:119–124. https://doi.org/10.1016/j.bbmt.2015.08.029
Pagliardini T, Harbi S, Fürst S et al (2018) Post-transplantation cyclophosphamide-based haploidentical versus Atg-based unrelated donor allogeneic stem cell transplantation for patients younger than 60 years with hematological malignancies: a single-center experience of 209 patients. Bone Marrow Transplant 54:1067–1076. https://doi.org/10.1038/s41409-018-0387-y
Chemnitz J, von Lilienfeld-Toal M, Holtick U et al (2011) Intermediate intensity conditioning regimen containing FLAMSA, treosulfan, cyclophosphamide, and ATG for allogeneic stem cell transplantation in elderly patients with relapsed or high-risk acute myeloid leukemia. Ann Hematol 91:47–55. https://doi.org/10.1007/s00277-011-1253-9
Devillier R, Granata A, Fürst S et al (2016) Low incidence of chronic GVHD after HLA-haploidentical peripheral blood stem cell transplantation with post-transplantation cyclophosphamide in older patients. Brit J Haematol 176:132–135. https://doi.org/10.1111/bjh.13923
Slade M, DiPersio JF, Westervelt P et al (2017) Haploidentical hematopoietic cell transplant with post-transplant cyclophosphamide and peripheral blood stem cell grafts in older adults with acute myeloid leukemia or Myelodysplastic syndrome. Biol Blood Marrow Tr 23:1736–1743. https://doi.org/10.1016/j.bbmt.2017.06.019
Yang J, Jiang J, Cai Y et al (2018) Low-dose anti-thymocyte globulin plus low-dose posttransplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical peripheral blood stem cell transplantation combined with unrelated cord blood for patients with hematologic malignancies: a prospective, phase II study. Bone Marrow Transplant 54:1049–1057. https://doi.org/10.1038/s41409-018-0382-3
Beelen D, Trenschel R, Stelljes M et al (2019) Treosulfan or busulfan plus fludarabine as conditioning treatment before allogeneic haemopoietic stem cell transplantation for older patients with acute myeloid leukaemia or myelodysplastic syndrome (MC-FludT.14/L): a randomised, non-inferiority, phase 3 trial. Lancet Haematol 7:e28–e39. https://doi.org/10.1016/s2352-3026(19)30157-7
Negrin RS (2015) Graft-versus-host disease versus graft-versus-leukemia. Hematology 2015:225–230. https://doi.org/10.1182/asheducation-2015.1.225
Kröger N, Zabelina T, Krüger W et al (2002) In vivo T cell depletion with pretransplant anti-thymocyte globulin reduces graft-versus-host disease without increasing relapse in good risk myeloid leukemia patients after stem cell transplantation from matched related donors. Bone Marrow Transplant 29:683–689. https://doi.org/10.1038/sj.bmt.1703530
Portier D, Sabo R, Roberts C et al (2012) Anti-thymocyte globulin for conditioning in matched unrelated donor hematopoietic cell transplantation provides comparable outcomes to matched related donor recipients. Bone Marrow Transplant 47:1513–1519. https://doi.org/10.1038/bmt.2012.81
Giebel S, Labopin M, Czerw T et al (2019) Impact of anti-thymocyte globulin on results of allogeneic peripheral blood stem cell transplantation for patients with Philadelphia-positive acute lymphoblastic leukaemia: an analysis by the acute leukemia working party of the EBMT. Eur J Cancer 106:212–219. https://doi.org/10.1016/j.ejca.2018.11.003
Ratanatharathorn V, Deol A, Ayash L et al (2014) Low-dose antithymocyte globulin enhanced the efficacy of tacrolimus and mycophenolate for GVHD prophylaxis in recipients of unrelated SCT. Bone Marrow Transplant 50:106–112. https://doi.org/10.1038/bmt.2014.203
Bashey A, Zhang X, Jackson K et al (2015) Comparison of outcomes of hematopoietic cell transplants from T-replete Haploidentical donors using post-transplantation cyclophosphamide with 10 of 10 HLA-A, -B, -C, -DRB1, and -DQB1 allele-matched unrelated donors and HLA-identical sibling donors: a multivariable analysis including disease risk index. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 22:125–133. https://doi.org/10.1016/j.bbmt.2015.09.002
How J, Slade M, Vu K et al (2017) T cell–replete peripheral blood Haploidentical hematopoietic cell transplantation with post-transplantation cyclophosphamide results in outcomes similar to transplantation from traditionally matched donors in active disease acute myeloid leukemia. Biol Blood Marrow Tr 23:648–653. https://doi.org/10.1016/j.bbmt.2017.01.068
Mariotti J, Devillier R, Bramanti S et al (2017) T cell-replete haploidentical transplantation with post-transplantation cyclophosphamide for Hodgkin lymphoma relapsed after autologous transplantation: reduced incidence of relapse and of chronic graft-versus-host disease compared with HLA-identical related donors. Biology Blood Marrow Transplant J Am Soc Blood Marrow Transplant 24:627–632. https://doi.org/10.1016/j.bbmt.2017.11.030
Mehta RS, Liba R, Chen J et al (2016) Post-transplantation cyclophosphamide versus conventional graft-versus-host disease prophylaxis in mismatched unrelated donor haematopoietic cell transplantation. Brit J Haematol 173:444–455. https://doi.org/10.1111/bjh.13977
Moiseev IS, Pirogova OV, Alyanski AL et al (2018) Risk-adapted GVHD prophylaxis with post-transplantation cyclophosphamide in adults after related, unrelated, and haploidentical transplantations. Eur J Haematol 100:395–402. https://doi.org/10.1111/ejh.13030
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Pasic, I., Lipton, J.H., Kim, D.D. et al. Post-transplant cyclophosphamide combined with anti-thymocyte globulin for graft-vs-host disease prophylaxis improves survival and lowers non-relapse mortality in older patients undergoing allogeneic hematopoietic cell transplantation. Ann Hematol 99, 1377–1387 (2020). https://doi.org/10.1007/s00277-020-04033-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00277-020-04033-2