C025 | Reduced-dose Post-transplant Cyclophosphamide in Allo-hsct: Outcomes From a Single-center Retrospective Study
Year: 2025
Type: article
Abstract: Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). To improve the efficacy/toxicity ratio remains a critical step. Between 2021 and 2025, 103 adult patients received PTCy either standard-dose PTCY (100 mg/kg) or reduced-dose PTCy (80 mg/kg) in those aged >65 years or with cardiac comorbidities. PTCy was administered at day +3 and +4. Acute GVHD (aGVHD) was diagnosed and graded using the MAGIC criteria. The primary objective was to compare the incidence of grade 2–4 and 3-4 aGVHD between the two dosing regimens. Secondary objectives included overall survival (OS) and progression free survival (PFS) at one year, incidence of moderate or severe chronic GVHD (cGVHD), and cumulative incidence of disease relapse. Patient and transplant characteristics are summarized in Table 1. The median follow-up for the entire cohort was 569 days (range, 28–1218 days). 31 received PTCy 80 mg/kg, while 72 PTCy 100 mg/kg in combination with cyclosporine A and mycophenolate mofetil.The cumulative incidence (CI) of grade II–IV acute GVHD was 27% in the whole population. In patients receiving PTCy 80 mg/kg was 36% and in those receiving PTCy 100 mg/kg was 23% (p= 0,23). The CI of grade III–IV aGVHD was 11% in the entire cohort, in the PTCy 80 mg/kg cohort was 20% and in the PTCy 100 mg/kg cohort was 6.7% (p=0,08). The 1-year overall survival (OS) was 66% in the entire cohort. 1-year OS was 45% in patients receiving PTCy 80 mg/kg and 75% in those receiving PTCy 100 mg/kg (p = 0.0031). The CI of moderate-to-severe cGVHD at 1 year, was 8.1% in the overall cohort, 12.5% in patients receiving PTCy 80mg/kg, and 6.9% in those receiving PTCy 100 mg/kg. The 1-year PFS was 61% in the entire cohort. In patients receiving PTCy 80 mg/kg, the 1-year PFS was 43%, while in those receiving PTCy 100 mg/kg was 67%.In univariate analysis, OS was worse for grade III-IV aGVHD, GVHD prophylaxis with PTCy 80 mg/kg, age >54 years, and HCT-CI >2. For PFS, the variables found to be statistically significant were grade III-IV aGVHD, age >54 years, HCT-CI >2, and donor age >35 years. Multivariate analyses will be conducted. The CI of relapse did not differ significantly between the two cohorts. Although the small cohort, these preliminary data suggest that reduced-dose PTCy (80 mg/kg) GVHD prophylaxis is associated with a higher incidence of both acute and chronic GVHD, as well as inferior OS and PFS.
Authors: C. Spoto, R. Bono, C. Rotolo, G. Sapienza, S. Tringali, A. Di Giorgio, C. Costanza, L. Castagna
Institutions: University of Palermo, Ospedale Vincenzo Cervello
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093122626
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