A recent study explored the use of post-transplant high-dose cyclophosphamide (PTCy) in haematopoietic cell transplantation (HCT) from mismatched unrelated donors (MMUD) in patients with acute myeloid malignancies.
The research focused on whether PTCy, along with a calcineurine inhibitor and mycophenolate mofetil, could improve outcomes and reduce the incidence and severity of acute graft-versus-host disease (aGvHD).
The study, conducted by the Italian GITMO, enrolled 77 patients across 26 Italian transplant centers. Most patients had acute myeloid leukemia (AML), with a smaller group having myelodysplastic syndromes (MDS).
The patients received a conditioning regimen of busulfan and fludarabine. The ethical committees of the participating centers approved the study (EURODRACT 2017-003530-85).
The primary goal was to measure the cumulative incidence (CI) of grade II-IV aGvHD. The results showed a 18. 2% CI of grade II-IV aGvHD and a 6. 5% CI for grade III-IV aGvHD.
The study found that 92% of patients achieved full-donor chimerism with complete neutrophil engraftment by day +30. The one-year cumulative incidence of chronic GvHD (cGvHD) was 13. 4%.
The one-year non-relapse mortality rate was 9. 1%, and the relapse rate was 23. 8%. One-year overall survival was 78. 6%, and graft-relapse-free survival was 55. 3%.
The study suggests that PTCy could be a game-changer in reducing aGvHD and improving outcomes for MMUD transplantation. However, it's important to note that the study was conducted in a specific group of patients, so the results might not apply to everyone.
While the findings are promising, more research is needed to confirm these results in larger and more diverse patient populations.
The study highlights the potential benefits of PTCy in HCT from MMUD. However, it's crucial to consider the broader context and limitations of the study.
The research raises questions about the optimal use of PTCy in different patient groups and the long-term effects of this treatment.
