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GVHD Outcomes With Post-Transplant Cyclophosphamide, Tacrolimus, and… in Stem Cell Transplant

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George Yaghmour MD interview on GVHD Outcomes With Post-Transplant Cyclophosphamide, Tacrolimus, and Mycophenolate Mofetil for Patients Undergoing Stem Cell Transplant

In our study uh we decided since we attended last plenary session in ash the havon 96 study that showed promising and significant improvement in the gvhd especially chronic gvhd by using post-transplant cyclophosphamide as a t-cells depletion in vivo t-cells depletion for gvhd prophylaxis in our study we want to analyze the outcome for adult patients 19 years

Old and older who received allergenic stem cell transplant for all indication including acute lymphoblastic leukemia acute myeloid leukemia mds and other diseases like aplastic anemia and hlh and other uh malignant hematologic disorder and we want to analyze those patients who the outcome especially the incidence of gvhd for patients who received uh t-cells

Depletion in vivo by using post-transplant cyclophosphamide and compared to the other gvsd regimen the methotrexate and definitely we wanted also to compare those patient population with the haplo half match identical allogeneic stem cell transplant core in our study retrospectively we evaluated the gvhd prophylaxis by either using t cells depletion in vivo

T-cells depletion by using the hopkins protocol of uh using day three and day four cyclophosphamide or 50 milligram dose combined with mycophenolate mmf cell cept starting day five up to day 35 combined with calcium inhibitor tachrolimus day five and con continued uh compared to the uh metatrader sad that we gave for gvhd prophylaxis day one and day three

Day six and day eleven combined with stacrolimus and that’s the two different uh gvhd prophylaxis regiment you we use for full match related or unrelated donor and we compare it to our uh haplo protocol using the hopkins protocol of the same t-cells depletion post-transplant side three and four combined with mmf and tacrolimus our primary endpoint is to

Investigate the total incidence of chronic gvhd and acute gvhd including the severity also as primary endpoint our secondary endpoint was to investigate the graft prelapse free survival 100-day mortality in each cohort and also leukemia-free survival and overall survival and basically the relapse rate in those different cohorts our analysis we found that a

Patient who proceeded with allergenic stem cell transplantation using full match related or unrelated donor in the cohort of using t-cells depletion by using post-transplant site with cell cep and tachrolimus statistically significant difference in the incidence of extensive chronic gvsd which is confirming the havona trial outcome and this finding translated

Into significant uh improvement in the graft relapse free survival in the cohort of the patient who received post transplant psi using full match related donor or full match unrelated donor and i want to highlight that in our uh post transplant psych cohort we had more patient with one allele or more mismatch in the unrelated donor cohort despite that we

Had an improve in the graft relapse free survival another highlight is our graft relapse for free survival rate is reached up to 60 percent or more which is way higher than what is reported previously including by the havon study and confirming and maybe uh pushing us for further prospective study and we know that there is a ctn protocol now comparing the

The same two cohort post transparent psi with metatrak shot in multi-center level uh randomized try as a conclusion when we do consider allergenic stem cell transplantation and we have been expanding the availability of using different donors including match-related mismatch-related unrelated donor or haplo i would say in our study we confirmed that if we use

Post-transplant cyclophosphamide day three and four it is safe and it’s promising that’s confirmed as a better graft relapse free survival and reduce the extensive incidence of gvhd in one year end points however we observed increased relapse rate and this data should be interpreted carefully and would love to see the randomized trial by ctn protocol that

Will confirm the benefit of survival at the level of prospective randomized trial

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GVHD Outcomes With Post-Transplant Cyclophosphamide, Tacrolimus, and… in Stem Cell Transplant By PracticeUpdate