Comparison of Post-transplant Cyclophosphamide Containing Immunosuppressive Regimen with Standard Immunosuppressive Regimen in Allogeneic Stem Cell Transplantation from Matched Sibling Donor

Abstract

Aim:Allogeneic stem cell transplantation (ASCT) is the only treatment that can cure most of malignant hematological diseases with the risk of some serious complications such as graft-versus-host disease (GVHD). GVHD can be got under control with post-transplant cyclophosphamide even in patients with haploidentical stem cell transplants. Here, we aimed to compare the effectiveness of post-transplant cyclophosphamide on GVHD with standard immunosuppressive therapy.Materials and Methods:Patients with high-risk hematologic malignancies, who received ASCT from human leukocyte antigen-matched sibling donors, were studied. Patients in the post-transplant cyclophosphamide group also used tacrolimus and mycophenolate mofetil; on the other side, standard immunosuppressive treatment with cyclosporine and methotrexate was used. The primary endpoint of the study was to compare the severe acute GVHD rate between the groups.Results:A total of 40 patients were included in the study. While severe (grade 3-4) GVHD was seen in three patients in the methotrexate-cyclosporin group, it was not seen in any patient in the post-transplant cyclophosphamide group. Also, 10th-month progress-free survival and overall survivals were 78.8% and 93.3% vs 56% and 72% in the post-transplant cyclophosphamide group and methotrexate-cyclosporin group, respectively.Conclusion:Cyclophosphamide can be the cheapest, most applicable, and clinically effective treatment in GVHD prophylaxis.

Keywords

• allogeneic stem cell transplant
• graft-versus-host disease
• cyclophosphamide