PTCy vs CNI–based GVHD prophylaxis in HLA-matched transplants for Hodgkin lymphoma: a study of the LWP of the EBMT

Juan Montoro*, Maud Ngoya, Alexander Kulagin, Sebastian Giebel, Annoek E.C. Broers, Stefania Bramanti, Khalid Halahleh, Jose A. Pérez-Simón, Carlos Solano, Tulay Ozcelik, Didier Blaise, Jaime Sanz, Marta Henriques, Régis Peffault de Latour, Rodrigo Martino, Christof Scheid, Laura Fox, Tomasz Gromek, Manuel Jurado, Ioanna SakellariGwendolyn Van Gorkom, Paola Matteucci, Arnon Nagler, Yener Koc, Bertram Glass

*Corresponding author for this work

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Abstract

Studies comparing the efficacy of posttransplant cyclophosphamide (PTCy) to conventional calcineurin inhibitor (CNI)–based graft-versus-host disease (GVHD) prophylaxis regimens in patients with Hodgkin lymphoma (HL) are scarce. This study aimed to compare the outcomes of patients with HL undergoing hematopoietic stem cell transplantation (HSCT) from HLA-matched donors who received GVHD prophylaxis with either PTCy- or conventional CNI-based regimens, using data reported in the European Society for Blood and Marrow Transplantation database between January 2015 and December 2022. Among the cohort, 270 recipients received conventional CNI-based prophylaxis and 176 received PTCy prophylaxis. Notably, PTCy prophylaxis was associated with delayed hematopoietic recovery but also with a lower risk of chronic (25% vs 43%; P < .001) and extensive chronic GVHD (13% vs 28%; P = .003) compared with the CNI-based cohort. The 2-year cumulative incidence of nonrelapse mortality and relapse was 11% vs 17% (P = .12) and 17% vs 30% (P = .007) for PTCy- and CNI-based, respectively. Moreover, the 2-year overall survival (OS), progression-free survival (PFS), and GVHD-free, relapse-free survival (GRFS) were all significantly better in the PTCy group compared with the CNI-based group: 85% vs 72% (P = .005), 72% vs 53% (P < .001), and 59% vs 31% (P < .001), respectively. In multivariable analysis, PTCy was associated with a lower risk of chronic and extensive chronic GVHD, reduced relapse, and better OS, PFS, and GRFS than the CNI-based platform. Our findings suggest that PTCy as GVHD prophylaxis offers more favorable outcomes than conventional CNI-based prophylaxis in adult patients with HL undergoing HSCT from HLA-matched donors.

Original languageEnglish
Pages (from-to)3985-3992
Number of pages8
JournalBlood Advances
Volume8
Issue number15
DOIs
Publication statusPublished - 13 Aug 2024

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© 2024 by The American Society of Hematology.

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