Post-transplant cyclophosphamide and single-agent tacrolimus as GvHD prophylaxis for allogeneic peripheral blood stem cell transplantation. Comparison between haploidentical and HLA matched/single-allele mismatched donors and impact of lower doses of PTCy.

Authors

A Esquirol, I Garcia-Cadenas, S Redondo, A Garrido, J Lopez, G Oñate, A Paviglianiti, A C Caballero, A Bosch, A Muntañola, S Saavedra, M Argüello-Tomas, J Briones, J Sierra, R Martino

Published in

Transplantation and cellular therapy. Nov 08, 2026. Epub Nov 08, 2026.

Abstract

Post-transplant cyclophosphamide (PT-Cy) at a standard dose of 50 mg/kg x 2 days (-50) is a standard prophylactic therapy for GvHD in combination with a calcineurin inhibitor and mycophenolate mofetil (MMF). In this retrospective study, we analyzed the results of 321 consecutive patients who received an allogeneic PBSC transplantation. Irrespective of donor type all patients received GVHD prophylaxis based on PT-Cy and single-agent tacrolimus. In non-haploidentical recipients, 2 sequential protocols of PT-Cy were used, with the standard dose in a first cohort and a reduced dose of PT-Cy in a latter cohort. Thus, the study included 103 haploidentical transplants with PT-Cy-50 and 218 recipients of an HLA-matched sibling (MSD), unrelated (MUD) or a 9/10 mismatched unrelated donor (mMUD), of whom 117 received the standard PT-Cy-50 dose and 101 received a reduced dose of PTCy (40 mg/kg x2 days in mMUDs and 30 mg/kg x 2 days in MSD/MUD). Both neutrophil (+22, +21, +19, p 0.001) and platelet engraftment (+27, +23, +17, p 0.001) was delayed in the haplo, non-haplo-50 vs PT-Cy-reduced groups, respectively. In multivariate analysis, there was no difference in the incidence of grade 2-4 aGvHD (p 0.37) or in the incidence of overall (p 0.14) and moderate-to-severe chronic GvHD (p 0.17) between the three groups. At 34 months, there were no differences in OS (p 0.23), GRFS (p0.46), relapse (p 0.15) or TRM (p 0.46). However, there was a statistical trend for higher grade 3-4 aGVHD with reduced-dose PT-CY in non-haplo recipients with a concomitant reduction in the 34-month relapse rate. In conclusion, PT-Cy with single-agent tacrolimus equates the outcomes with any donor type. Although reducing the dose of PT-Cy reduces Cy-induced toxicities, a mild increase in aGVHD may be seen.

PMID:
43000101
Bibliographic data and abstract were imported from PubMed on 09 Nov 2026.

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