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Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation

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Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation. / Sahebi, Firoozeh; Eikema, Dirk-Jan; Koster, Linda; Kroger, Nicolaus; Meijer, Ellen; van Doesum, Jaap A; Rovira, Montserrat; Koc, Yener; Angelucci, Emanuele; Blaise, Didier; Sammassimo, Simona; McDonald, Andrew; Arroyo, Concepcion Herrera; Sanchez, James F; Forcade, Edouard; Castagna, Luca; Stölzel, Friedrich; Sanz, Jaime; Tischer, Johanna; Ciceri, Fabio; Valcarcel, David; Proia, Anna; Hayden, Patrick J; Beksac, Meral; Yakoub-Agha, Ibrahim; Schönland, Stefan.

In: TRANSPL CELL THER, Vol. 27, No. 12, 12.2021, p. 999.e1-999.e10.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Sahebi, F, Eikema, D-J, Koster, L, Kroger, N, Meijer, E, van Doesum, JA, Rovira, M, Koc, Y, Angelucci, E, Blaise, D, Sammassimo, S, McDonald, A, Arroyo, CH, Sanchez, JF, Forcade, E, Castagna, L, Stölzel, F, Sanz, J, Tischer, J, Ciceri, F, Valcarcel, D, Proia, A, Hayden, PJ, Beksac, M, Yakoub-Agha, I & Schönland, S 2021, 'Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation', TRANSPL CELL THER, vol. 27, no. 12, pp. 999.e1-999.e10. https://doi.org/10.1016/j.jtct.2021.09.008

APA

Sahebi, F., Eikema, D-J., Koster, L., Kroger, N., Meijer, E., van Doesum, J. A., Rovira, M., Koc, Y., Angelucci, E., Blaise, D., Sammassimo, S., McDonald, A., Arroyo, C. H., Sanchez, J. F., Forcade, E., Castagna, L., Stölzel, F., Sanz, J., Tischer, J., ... Schönland, S. (2021). Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation. TRANSPL CELL THER, 27(12), 999.e1-999.e10. https://doi.org/10.1016/j.jtct.2021.09.008

Vancouver

Sahebi F, Eikema D-J, Koster L, Kroger N, Meijer E, van Doesum JA et al. Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation. TRANSPL CELL THER. 2021 Dec;27(12):999.e1-999.e10. https://doi.org/10.1016/j.jtct.2021.09.008

Bibtex

@article{61d6a82680214827a373795dbe2a47b3,
title = "Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation",
abstract = "Graft-versus-host disease (GVHD) remains among the major causes of treatment failure in patients with multiple myeloma (MM) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The use of post-transplantation cyclophosphamide (PT-Cy) is now a well-established and widely used method for GVHD prophylaxis after HLA haploidentical HCT. However, the rationale for using PT-Cy in the setting of matched donor transplantation is less apparent, given the lesser degree of bidirectional alloreactivity. In this retrospective study, we investigated the role of PT-Cy as GVHD prophylaxis in patients with multiple myeloma underoing allo-HCT, among different donor types, to determine cumulative incidence of acute and chronic GVHD and impact on engraftment, progression-free survival (PFS), GVHD-free/relapse- free survival (GRFS), overall survival (OS), and NRM A total of 295 patients with MM underwent allo-HCT using grafts from a matched related donor (MRD; n = 67), matched unrelated donor (MUD; n = 72), mismatched related or unrelated donor (MMRD/MMUD, 1 antigen; n = 27), or haploidentical donor (haplo; n = 129) using PT-Cy between 2012 and 2018. In addition to PT-Cy, agents used in GVHD prophylaxis included calcineurin inhibitors in 239 patients (81%), with mycophenolate mofetil in 184 of those 239 (77%). For grade II-IV acute GVHD, the cumulative incidence at day +100 was 30% (95% confidence interval [CI], 25% to 36%), 9% (95% CI, 5% to 12%) for grade III-IV acute GVHD, and 27% (95% CI, 21% to 32%) for chronic GVHD (limited, 21%; extensive, 6%), with no differences by donor type. The median time to neutrophil engraftment was 19d (95% CI, 18-19), with no significant difference by donor type. The median time to platelet engraftment was delayed in haploidentical donor graft recipients (27 days versus 21 days; P < .001). Two-year OS, PFS, GRFS, and NRM were 51% (95% CI, 45% to 58%), 26% (95% CI, 20% to 32%), 24% (95% CI, 18% to 30%), and 19% (95% CI, 14% to 24%), respectively, with no significant difference between different donor types. In multivariable analyses, compared with the haplo donors, the use of MRDs was associated with significantly better OS (hazard ratio [HR], 0.6; 95% CI, 0.38 to 0.95; P = .029), and the use of MUDs was associated with a significantly higher GRFS (HR, 0.63; 95% CI, 0.42 to 0.97; P = .034). There was a trend toward improved PFS with use of MUDs (HR, 0.69; 95% CI, 0.46 to 1.04; P = .08). Our data show that PT-Cy in MM patients undergoing allo-HCT resulted in low rates of acute and chronic GVHD and led to favorable survival, especially in the matched related donor setting. {\textcopyright} 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.",
author = "Firoozeh Sahebi and Dirk-Jan Eikema and Linda Koster and Nicolaus Kroger and Ellen Meijer and {van Doesum}, {Jaap A} and Montserrat Rovira and Yener Koc and Emanuele Angelucci and Didier Blaise and Simona Sammassimo and Andrew McDonald and Arroyo, {Concepcion Herrera} and Sanchez, {James F} and Edouard Forcade and Luca Castagna and Friedrich St{\"o}lzel and Jaime Sanz and Johanna Tischer and Fabio Ciceri and David Valcarcel and Anna Proia and Hayden, {Patrick J} and Meral Beksac and Ibrahim Yakoub-Agha and Stefan Sch{\"o}nland",
note = "Copyright {\textcopyright} 2021. Published by Elsevier Inc.",
year = "2021",
month = dec,
doi = "10.1016/j.jtct.2021.09.008",
language = "English",
volume = "27",
pages = "999.e1--999.e10",
journal = "TRANSPL CELL THER",
issn = "2666-6375",
publisher = "Elsevier BV",
number = "12",

}

RIS

TY - JOUR

T1 - Post-Transplantation Cyclophosphamide for Graft-versus- Host Disease Prophylaxis in Multiple Myeloma Patients Who Underwent Allogeneic Hematopoietic Cell Transplantation

AU - Sahebi, Firoozeh

AU - Eikema, Dirk-Jan

AU - Koster, Linda

AU - Kroger, Nicolaus

AU - Meijer, Ellen

AU - van Doesum, Jaap A

AU - Rovira, Montserrat

AU - Koc, Yener

AU - Angelucci, Emanuele

AU - Blaise, Didier

AU - Sammassimo, Simona

AU - McDonald, Andrew

AU - Arroyo, Concepcion Herrera

AU - Sanchez, James F

AU - Forcade, Edouard

AU - Castagna, Luca

AU - Stölzel, Friedrich

AU - Sanz, Jaime

AU - Tischer, Johanna

AU - Ciceri, Fabio

AU - Valcarcel, David

AU - Proia, Anna

AU - Hayden, Patrick J

AU - Beksac, Meral

AU - Yakoub-Agha, Ibrahim

AU - Schönland, Stefan

N1 - Copyright © 2021. Published by Elsevier Inc.

PY - 2021/12

Y1 - 2021/12

N2 - Graft-versus-host disease (GVHD) remains among the major causes of treatment failure in patients with multiple myeloma (MM) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The use of post-transplantation cyclophosphamide (PT-Cy) is now a well-established and widely used method for GVHD prophylaxis after HLA haploidentical HCT. However, the rationale for using PT-Cy in the setting of matched donor transplantation is less apparent, given the lesser degree of bidirectional alloreactivity. In this retrospective study, we investigated the role of PT-Cy as GVHD prophylaxis in patients with multiple myeloma underoing allo-HCT, among different donor types, to determine cumulative incidence of acute and chronic GVHD and impact on engraftment, progression-free survival (PFS), GVHD-free/relapse- free survival (GRFS), overall survival (OS), and NRM A total of 295 patients with MM underwent allo-HCT using grafts from a matched related donor (MRD; n = 67), matched unrelated donor (MUD; n = 72), mismatched related or unrelated donor (MMRD/MMUD, 1 antigen; n = 27), or haploidentical donor (haplo; n = 129) using PT-Cy between 2012 and 2018. In addition to PT-Cy, agents used in GVHD prophylaxis included calcineurin inhibitors in 239 patients (81%), with mycophenolate mofetil in 184 of those 239 (77%). For grade II-IV acute GVHD, the cumulative incidence at day +100 was 30% (95% confidence interval [CI], 25% to 36%), 9% (95% CI, 5% to 12%) for grade III-IV acute GVHD, and 27% (95% CI, 21% to 32%) for chronic GVHD (limited, 21%; extensive, 6%), with no differences by donor type. The median time to neutrophil engraftment was 19d (95% CI, 18-19), with no significant difference by donor type. The median time to platelet engraftment was delayed in haploidentical donor graft recipients (27 days versus 21 days; P < .001). Two-year OS, PFS, GRFS, and NRM were 51% (95% CI, 45% to 58%), 26% (95% CI, 20% to 32%), 24% (95% CI, 18% to 30%), and 19% (95% CI, 14% to 24%), respectively, with no significant difference between different donor types. In multivariable analyses, compared with the haplo donors, the use of MRDs was associated with significantly better OS (hazard ratio [HR], 0.6; 95% CI, 0.38 to 0.95; P = .029), and the use of MUDs was associated with a significantly higher GRFS (HR, 0.63; 95% CI, 0.42 to 0.97; P = .034). There was a trend toward improved PFS with use of MUDs (HR, 0.69; 95% CI, 0.46 to 1.04; P = .08). Our data show that PT-Cy in MM patients undergoing allo-HCT resulted in low rates of acute and chronic GVHD and led to favorable survival, especially in the matched related donor setting. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

AB - Graft-versus-host disease (GVHD) remains among the major causes of treatment failure in patients with multiple myeloma (MM) undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The use of post-transplantation cyclophosphamide (PT-Cy) is now a well-established and widely used method for GVHD prophylaxis after HLA haploidentical HCT. However, the rationale for using PT-Cy in the setting of matched donor transplantation is less apparent, given the lesser degree of bidirectional alloreactivity. In this retrospective study, we investigated the role of PT-Cy as GVHD prophylaxis in patients with multiple myeloma underoing allo-HCT, among different donor types, to determine cumulative incidence of acute and chronic GVHD and impact on engraftment, progression-free survival (PFS), GVHD-free/relapse- free survival (GRFS), overall survival (OS), and NRM A total of 295 patients with MM underwent allo-HCT using grafts from a matched related donor (MRD; n = 67), matched unrelated donor (MUD; n = 72), mismatched related or unrelated donor (MMRD/MMUD, 1 antigen; n = 27), or haploidentical donor (haplo; n = 129) using PT-Cy between 2012 and 2018. In addition to PT-Cy, agents used in GVHD prophylaxis included calcineurin inhibitors in 239 patients (81%), with mycophenolate mofetil in 184 of those 239 (77%). For grade II-IV acute GVHD, the cumulative incidence at day +100 was 30% (95% confidence interval [CI], 25% to 36%), 9% (95% CI, 5% to 12%) for grade III-IV acute GVHD, and 27% (95% CI, 21% to 32%) for chronic GVHD (limited, 21%; extensive, 6%), with no differences by donor type. The median time to neutrophil engraftment was 19d (95% CI, 18-19), with no significant difference by donor type. The median time to platelet engraftment was delayed in haploidentical donor graft recipients (27 days versus 21 days; P < .001). Two-year OS, PFS, GRFS, and NRM were 51% (95% CI, 45% to 58%), 26% (95% CI, 20% to 32%), 24% (95% CI, 18% to 30%), and 19% (95% CI, 14% to 24%), respectively, with no significant difference between different donor types. In multivariable analyses, compared with the haplo donors, the use of MRDs was associated with significantly better OS (hazard ratio [HR], 0.6; 95% CI, 0.38 to 0.95; P = .029), and the use of MUDs was associated with a significantly higher GRFS (HR, 0.63; 95% CI, 0.42 to 0.97; P = .034). There was a trend toward improved PFS with use of MUDs (HR, 0.69; 95% CI, 0.46 to 1.04; P = .08). Our data show that PT-Cy in MM patients undergoing allo-HCT resulted in low rates of acute and chronic GVHD and led to favorable survival, especially in the matched related donor setting. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

U2 - 10.1016/j.jtct.2021.09.008

DO - 10.1016/j.jtct.2021.09.008

M3 - SCORING: Journal article

C2 - 34543768

VL - 27

SP - 999.e1-999.e10

JO - TRANSPL CELL THER

JF - TRANSPL CELL THER

SN - 2666-6375

IS - 12

ER -