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Post-transplantation cyclophosphamide as graft versus host disease prophylaxis in patients with acute leukemia received fully matched allogeneic HSCT or haplo-identical HSCT


Hematology & Transfusion International Journal
Alaa Elshamy,1 Essam Abd Elmohsen,1 Mai Denewer,2 Mohamed Mabed2

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Abstract

Post-transplant Cyclophosphamide (PT-Cy) has proved efficacy as GVHD prophylaxis regimen after HSCT.

However, experiences are limited with controversial results. We herein, assess the efficacy of PT-Cy compared to Methotrexate regimen. Eighty patients with acute leukemia received a fully matched allogeneic HSCT or a Haplo-identical HSCT were analyzed. Group I (Historical group) included 40 patients received Methotrexate, Cyclosporine and MMF. They were transplanted with fully matched allogeneic transplantation. Group II included 40 patients received PT-Cy, Cyclosporine and MMF. They were subdivided to 2 subgroups. Subgroup IIA included 22 patients received fully matched allo- HSCT and subgroup IIB included 18 patients received Haplo- HSCT. Group IIA showed significantly lower incidence of cGVHD when compared to group I with an incidence of 22.7% and 67% respectively (P = 0.002). Group IIA was associated with reduced risk of extensive cGVHD compared to MTX group (P =0.003). No significant differences were found in the incidence of aGVHD, relapse rates, relapse or non-relapse related mortalities, OS and DFS data among the different groups (P>0.05). In conclusion, PT-Cy with addition of IS drugs has statistically significant difference in reducing the incidence of cGvHD in both fully matched and Haplo SCT with less hepatic and renal toxicity.

Keywords

acute graft-versus-host-disease, acute leukemia, chronic graft-versus-hostdisease, cyclophosphamide, immunosuppressives, prophylaxis

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