Page 11 - Haematologica Vol. 109 - July 2024

LANDMARK PAPER IN HEMATOLOGY M. Eapen
Figure 1. Nonmyeloablative haploidentical bone marrow transplant conditioning and immunosuppressive regimens. G-CSF: gran- ulocyte colony-stimulating factor. Adapted with permission from Blood. 2021;137(3):420-428.
included 90% of the planned accrual. This trial concluded that both alternative sources of donor cells extend access to transplantation. Lower non-relapse mortality and high- er 2-year survival favored haploidentical transplantation.3 Consequently, there are substantially more haploidentical transplants and very few umbilical cord blood transplants performed in the USA now.
Control of GvHD is one of the most important determinants of a successful outcome after allogeneic hematopoietic cell transplantation and, for approximately four decades, a cal- cineurin inhibitor with methotrexate became the standard regimen for GvHD prevention. Immunosuppression with posttransplant high-dose cyclophosphamide, tacrolimus and mycophenolate mofetil compared to tacrolimus and metho- trexate was recently studied in a randomized trial for adults
References
1. Luznik L, Jalla S, Engstrom LW, Iannone R, Fuchs EJ. Durable engraftment of major histocompatibility complex-incompatible cells after nonmyeloablative conditioning with fludarabine, low-dose total body irradiation, and posttransplantation cyclophosphamide. Blood. 2001;98(12):3456-3464.
2. Luznik L, O’Donnell PV, Symons HJ, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose,
with hematologic malignancy.4 Patients underwent trans- plantation from an HLA-matched sibling or HLA-matched or mismatched unrelated donor. This trial concluded that the rate of GvHD-free, relapse-free survival was higher after immunosuppression with posttransplant high-dose cyclo- phosphamide, tacrolimus and mycophenolate mofetil and extends the application of this approach to GvHD preven- tion. In conclusion, immunosuppression with posttransplant, high-dose cyclophosphamide, tacrolimus and mycophenolate mofetil increased access to transplantation and has set a new standard for GvHD prevention after hematopoietic cell transplantation.
Disclosures
No conflicts of interest to disclose.
posttransplantation cyclophosphamide. Biol Blood Marrow
Transplant. 2008;14(6):641-650.
3. Fuchs EJ, O’Donnell PV, Eapen M, et al. Double unrelated
umbilical cord blood vs. HLA-haploidentical bone marrow
transplantation: BMT CTN 1101 trial. Blood. 2021;137(3):420-428. 4. Bolanos-Meade J, Hamadani M, Wu J, et al. Post-
transplantation cyclophosphamide-based graft-versus-host disease prophylaxis. N Engl J Med. 2023;388(25):2338-2348.
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