Mild Acute Graft-Versus-Host Disease Improves Outcomes After HLA-Haploidentical-Related Donor Transplantation Using Posttransplant Cyclophosphamide and Cord Blood Transplantation

Overview

Journal Cell Transplant

Specialties Cell Biology
General Surgery

Date 2023 Aug 30

PMID 37646153

Authors

Fumiya Wada

Junya Kanda

Kimimori Kamijo

Masashi Nishikubo

Satoshi Yoshioka

Takayuki Ishikawa

Yasunori Ueda

Takashi Akasaka

Yasuyuki Arai

Kiyotaka Izumi

Hirokazu Hirata

Takashi Ikeda

Akihito Yonezawa

Naoyuki Anzai

Mitsumasa Watanabe

Kazunori Imada

Kazuhiro Yago

Naoki Tamura

Mitsuru Itoh

Yuki Masuo

Akane Kunitomi

Tomoharu Takeoka

Toshiyuki Kitano

Nobuyoshi Arima

Masakatsu Hishizawa

Kohsuke Asagoe

Tadakazu Kondo

Akifumi Takaori-Kondo

Affiliations

Soon will be listed here.

Abstract

Haploidentical-related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) and cord blood transplantation (CBT) are valid alternatives for patients with hematological malignancies when HLA-matched donor transplantation (MDT) is unavailable. However, the effects of graft-versus-host disease (GVHD) on outcomes after these transplants have not been fully elucidated. Therefore, we evaluated the effects of acute and chronic GVHD on transplant outcomes after PTCy-haplo transplants and compared them with CBT and MDT. We included a total of 914 adult patients with hematological malignancies in the Kyoto Stem Cell Transplantation Group registry who received PTCy-haplo (N = 120), CBT (N = 402), and MDT (N = 392), and achieved neutrophil engraftment. A multivariate analysis revealed that grade I-II acute GVHD improved of overall survival (OS) after PTCy-haplo [hazard ratio (HR) = 0.39, = 0.018] and CBT (HR = 0.48, < 0.001), but not after MDT (HR = 0.80, = 0.267) compared with patients without acute GVHD. Grade I-II acute GVHD had a trend toward reducing the risk of nonrelapse mortality (NRM) after PTCy-haplo (HR = 0.13, = 0.060) and this positive effect was significant after CBT (HR = 0.39, = 0.003). A negative impact of grade III-IV acute GVHD on NRM was observed after CBT and MDT, but not after PTCy-haplo. Limited chronic GVHD had a positive impact on OS after CBT and MDT, but not after PTCy-haplo. In conclusion, mild acute GVHD improved outcomes after PTCy-haplo and CBT, and limited chronic GVHD improved outcomes after CBT and MDT. These data indicated that the effects of GVHD on transplant outcomes depended on transplant platforms.

Citing Articles

Investigation of Allogeneic Neutrophil Transfusion in Improving Survival Rates of Severe Infection Mice.

Li L, Yang Y, Guo Z, Gao X, Liu L, Huang J Cell Transplant. 2024; 33:9636897241228031.

PMID: 38353224 PMC: 10868470. DOI: 10.1177/09636897241228031.

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