Di-san junyi daxue xuebao (Sep 2020)
PT-Cy combined with ruxolitinib and tocilizumab prevents aGVHD after haploidentical HSCT
Abstract
Objective To evaluate the efficacy of post-transplant cyclophosphamide (PT-Cy) combined with ruxolitinib and tocilizumab in the prevention of acute graft versus host disease (aGVHD) after haploidentical allogeneic peripheral blood hematopoietic stem cell transplantation (HSCT) by a single-arm prospective study. Methods A total of 56 patients undergoing haploidentical allogeneic peripheral blood HSCT in our department from January 1, 2019 to March 1, 2020 were recruited in this study. The GHVD prevention regiments included: cyclophosphamide 40 mg/kg×2 d (+3～+4 d), ciclosporin 2 mg/kg (+5～+180 d) and mycophenolate sodium enteric-coated tablets 10 mg/kg (+5～+35 d), tocilizumab 8 mg/kg×1 d (-1 d), and ruxolitinib (-1～+180 d). The effect of transplantation and adverse effect of aGVHD were observed. Results The implantation of stem cells was completed successfully among all the 56 patients (100%), with an implantation time of neutrophils of 13 d and of platelets of 17 d. The incidence of grade Ⅱ～Ⅳ aGVHD was 23.2%, and that of grade Ⅲ～Ⅳ was 12.5%. One patient died due to poor control of aGVHD, 6 patients had pulmonary infection; 12 patients had human cytomegalovirus infection or persistent viral copy number rise; 8 patients had Epstein-Barr virus infection or persistent viral copy number rise; and 8 patients had hematopoietic suppression. During the follow-up of 2～16 months (median 8 months), nonrelapse mortality (NRM) was 7.2%, and overall survival rate (OS) was 91.4%. Conclusion ;PT-Cy combined with ruxolitinib and tocilizumab regimen can effectively prevent aGVHD for haplotype concomitant transplantation patients. No significant increases of bacterial and viral infections are observed. This program has a higher incidence of hematopoietic suppression and a good overall tolerance.
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