Post-transplantation cyclophosphamide (PT-Cy) use is a recent graft-versus-host disease (GVHD) prophylaxis strategy for patients undergoing allogeneic stem cell transplantation (allo-HSCT). PT-Cy combined with two immunosuppressants is now widely used after haplo-identical (haplo) and HLA-matched peripheral blood stem cell (PBSC) transplantations with promising GVHD and GVHD and relapse-free survival (GRFS) probabilities. Although appealing, these results may benefit from improvement notably outside matched sibling donor transplantation, and should be investigated in various ethnic populations. Therefore, we report our experience of GVHD prophylaxis regimen combining PT-Cy and tacrolimus with addition of post-engraftment low-dose anti-thymocyte globulin (ATG) in allogeneic stem cell transplantation from haplo-identical donors (Haplo). Fifty-three patients were included in the analysis. All patients received myeloablative or intensified sequential conditioning regimen. The median follow-up was 397 (range, 191~762) days. The cumulative incidences of 100-day grade II-IV acute GVHD was 9.4±4.1%, and no case of grade III-IV acute GVHD was documented. The cumulative incidences of 1-year chronic GVHD and moderate-to-severe chronic GVHD were 18.9±5.4% and 7.5±3.7%, respectively. The non-relapse mortality at day+100 and 1 year were 9.4±4.4% and 11.3±4.4%, respectively. The cumulative incidence of relapse at 1 year was 3.8±2.7%. The 1-year probability of DFS and OS were 84.5% (95%CI, 75.2~95.0%) and 88.7% (95% CI, 80.5~97.6%), respectively. The 1-year GRFS was estimated as 75.0% (95%CI, 64.1~87.8%). Our results suggested that a combination of PT-Cy, tacrolimus, and low-dose post-engraftment ATG was a promising GVHD prophylaxis with low incidence of acute GVHD in the haplo-transplantation setting.

No relevant conflicts of interest to declare.

Author notes


Asterisk with author names denotes non-ASH members.

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