Purpose Of The Review: The purpose of this review is to outline current graft versus host disease (GvHD) prophylaxis, in the era of posttransplant cyclophosphamide (PTCY), in patients with malignant and nonmalignant hematologic disorders. The original combination of PTCY with a calcineurin inhibitor (CNI) and mycophenolate (MMF), reported from the Johns Hopkins University in Baltimore, was designed for patients receiving a graft from a donor mismatched at one haplotype, so called haploidentical donor (HAPLO). In the past decade, PTCY has been widely used in HAPLO transplants worldwide, confirming the amazing efficacy of PTCY in preventing GvHD in mismatched grafts.
Recent Findings: More recently, PTCY is being tested also in grafts from human leukocyte antigen (HLA) identical related or unrelated donors. In the present review we will also answer several open questions, such as: PTCY and cardiac toxicity; PTCY dose; PTCY timing; PTCY and antithymocyte globulin (ATG); engraftment kinetics; infections; PTCY and leukemia relapse; PTCY and HLA identical grafts.
Summary: PTCY is currently one of the most effective measures to prevent GvHD, and can be customized in different transplant platforms, together with other immunosuppressive agents. There is place for improvement, and several possible modifications of PTCY dose and schedule can be tested in prospective trials.
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Incidence, risk factors, and outcomes of BK hemorrhagic cystitis in hematopoietic stem cell transplantation from HLA-matched and haploidentical donors with post-transplant cyclophosphamide.
Transplant Cell Ther
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Hematology Department, Hospital Universitari i Politècnic La Fe, València, Spain; Hematology Research Group, Institut d'Investigació Sanitària La Fe, València, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain; Medicine Department, Universitat de València, Spain.
Background: BK hemorrhagic cystitis (BK-HC) is a common complication following hematopoietic stem cell transplantation (HSCT), particularly when posttransplant cyclophosphamide (PTCy) is used as graft-versus-host disease (GVHD) prophylaxis. However, comparative studies of BK-HC incidence in matched sibling donors (MSD) and unrelated donors (MUD) often include small haploidentical (HAPLO) donor cohorts and usually lack detailed information on disease evolution, coinfections, management and impact on outcomes.
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What should be the optimal dose of post-transplantation cyclophosphamide for GVHD prophylaxis in allogeneic stem cell transplantation?
Transfus Apher Sci
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University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey.
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Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
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View Article and Find Full Text PDFIncidence and impact of invasive fungal infection comparing post-transplant cyclophosphamide with cyclosporine plus methotrexate GVHD prophylaxis in allogeneic HSCT.
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Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
Background: In recent years, haploidentical hematopoietic stem cell transplantation (haploHSCT) with post-transplant cyclophosphamide (PTCy) has become increasingly prevalent. However, the precise impact of invasive fungal disease (IFD) in relation to graft-versus-host disease (GVHD) prophylaxis and donor type remains to be elucidated.
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Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Emerging Medicine for Integrated Therapeutics (EMIT), Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan.
Article Synopsis
- The study compares outcomes of unrelated cord blood transplantation (UCBT) and haploidentical transplantation with posttransplant cyclophosphamide (PTCy-haplo) in patients without a matched donor, focusing on the impact of CD34 cell counts in cord blood.
- Data from 2014 to 2020 was analyzed, categorizing UCBT cases into those with high (≥0.84 × 10/kg) and low (<0.84 × 10/kg) CD34 cell counts, revealing better neutrophil engraftment in PTCy-haplo compared to both UCB groups.
- While UCB-H showed similar nonrelapse mortality (NRM) and overall survival
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