Single-agent GVHD prophylaxis with posttransplantation cyclophosphamide after myeloablative, HLA-matched BMT for AML, ALL, and MDS

Christopher G. Kanakry, Hua Ling Tsai, Javier Bolaños-Meade, B. Douglas Smith, Ivana Gojo, Jennifer A. Kanakry, Yvette L. Kasamon, Douglas E. Gladstone, William Matsui, Ivan Borrello, Carol Ann Huff, Lode J. Swinnen, Jonathan D. Powell, Keith Pratz, Amy E. DeZern, Margaret M. Showel, A Michael McDevitt, Robert A. Brodsky, Mark J. Levis, Richard F. AmbinderEphraim J. Fuchs, Gary L. Rosner, Richard J. Jones, Leo Luznik

Research output: Contribution to journalArticlepeer-review

103 Scopus citations

Abstract

High-dose, posttransplantation cyclophosphamide (PTCy) reduces severe graft-versus-host disease (GVHD) after allogeneic blood or marrow transplantation (alloBMT), but the impact of PTCy on long-term, disease-specific outcomes is unclear. We conducted a retrospective study of 209 consecutive adult patients transplanted for acute myeloid leukemia (AML, n = 138), myelodysplastic syndrome (n = 28), or acute lymphoblastic leukemia (ALL, n = 43) using PTCy as sole GVHD prophylaxis after myeloablative conditioning and HLA-matched-related or -unrelated T-cell-replete allografting. At alloBMT, 30% of patients were not in morphologic complete remission. The cumulative incidences of grades II to IV and III to IV acute GVHD at 100 days and chronic GVHD at 2 years were 45%, 11%, and 13%, respectively. Forty-three percent of patients did not require immunosuppression for any reason beyond PTCy. At 3 years, relapse cumulative incidence was 36%, disease-free survival was 46%, survival free of disease and chronic GVHD was 39%, and overall survival was 58%. Lack of remission at alloBMT, adverse cytogenetics, and low allograft nucleated cell dose were associated with inferior survival for AML patients. Minimal residual disease but not t(9;22) was associated with inferior outcomes for ALL patients. The ability to limit posttransplantation immunosuppression makes PTCy a promising transplantation platform for the integration of postgrafting strategies to prevent relapse.

Original languageEnglish (US)
Pages (from-to)3817-3827
Number of pages11
JournalBlood
Volume124
Issue number25
DOIs
StatePublished - Dec 11 2014

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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