Experimental Prophylaxis Beneficial for Patients Undergoing HSCT

FRIDAY, June 23, 2023 (HealthDay News) -- For patients with hematologic cancer undergoing allogeneic hematopoietic stem-cell transplantation (HSCT), graft-versus-host-disease (GVHD)-free, relapse-free survival is more common among those receiving cyclophosphamide-tacrolimus-mycophenolate mofetil prophylaxis compared with tacrolimus-methotrexate prophylaxis, according to a study published in the June 22 issue of the New England Journal of Medicine.

Javier Bolaños-Meade, M.D., from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, and colleagues randomly assigned adults with hematologic cancers to receive cyclophosphamide-tacrolimus-mycophenolate mofetil (experimental prophylaxis) or tacrolimus-methotrexate (standard prophylaxis; 214 and 217 patients, respectively). After reduced-intensity conditioning, the patients underwent HSCT from a human leukocyte antigen-matched related donor or a matched or 7/8 mismatched unrelated donor.

The researchers found that GVHD-free, relapse-free survival was significantly more common in the experimental-prophylaxis versus the standard-prophylaxis group (hazard ratio for grade III or IV acute GVHD, chronic GVHD, disease relapse or progression, or death, 0.64). At one year, the adjusted GVHD-free, relapse-free survival was 52.7 and 34.9 percent, with experimental or standard prophylaxis, respectively. Less severe acute or chronic GVHD was seen for patients in the experimental-prophylaxis group, and they also had a higher incidence of immunosuppression-free survival at one year. No substantial between-group differences were seen in overall and disease-free survival, relapse, transplantation-related death, or engraftment.

"The results also suggested longer immunosuppression-free survival and a lower incidence of severe acute GVHD and of chronic GVHD with the experimental-prophylaxis regimen, without an early (less than or equal to one year) compromise in disease control, although these results require confirmation," the authors write.

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