Safety of Post-transplant Cyclophosphamide as a Single Agent for Graft-Versus-Ho...

연구 요약

Safety of Post-transplant Cyclophosphamide as a Single Agent for Graft-Versus-Host Disease Prophylaxis After Human Leukocyte Antigen (HLA)-Matched Transplantation With the Japanese Population: A Single-Center Phase Ⅰ/Ⅱ Study.

Cureus 학술지에 발표된 이 연구는 Joyce M, Kurita N, Mathis BJ 외 연구팀이 수행하였습니다.

이 연구는 'Safety of Post-transplant Cyclophosphamide as a Single Agent for Graft-Versus-Host Disease Prophylaxis After Human Leukocyte Antigen (HLA)-Matched Transplantation With the Japanese Population: A Single-Center Phase Ⅰ/Ⅱ Study.'에 대한 과학적 분석을 제공합니다.

핵심 내용

Background Graft-versus-host disease (GVHD) is a severe complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although calcineurin inhibitor (CNI)-containing GVHD prophylaxis is currently standard, it has the disadvantages of nephrotoxicity, a risk for thrombotic microangiopathy, drug interaction, and a requirement for monitoring blood concentration. Therefore, we conducted a prospective trial with the Japanese population undergoing allo-HSCT from an HLA-matched donor to investigate the safety and preliminary efficacy of single-agent post-transplant cyclophosphamide (PTCy) for GVHD prophylaxis. Methods This single-center phase I/II trial was a prospective study registered in the UMIN Clinical Trials Registry (UMINID: UMIN000028779) on November 1, 2017, and enrolled patients aged 16-60 years old with hematological malignancies in remission but without a history of previous allo-HSCT. Myeloablative conditioning (fludarabine 120 mg/m2 and total body irradiation 12 Gy) was followed by bone marrow transplantation from an HLA-matched donor. Cyclophosphamide (50 mg/kg) was administered on days 3 and 4. The primary endpoint was GVHD-free, relapse-free survival (GRFS) at six months after transplantation. Secondary endpoints included overall survival, incidences of relapse, non-relapse mortality (NRM), and acute and chronic GVHD (a/cGVHD). The prespecified sample size was 20. Results Four patients were enrolled, and one patient withdrew due to medication non-compliance. The GRFS at six months post-transplant was 2 out of 3 evaluable patients (66.7%). Grade 2 aGVHD was observed in 2/3 (66.7%), and neither grade 3-4 aGVHD nor moderate-to-severe cGVHD appeared within six months after transplantation. Two patients required additional cyclosporine administration because of hemophagocytic lymphohistiocytosis and grade 2 skin aGVHD, respectively, which improved promptly after cyclosporine administration. One patient relapsed, and NRM was not observed. Overall survival at six months was 3/3 (100%). The study was terminated early with poor recruitment. Conclusions PTCy alone may ensure safety, but PTCy alone may ensure safety. However, in this small cohort, PTCy monotherapy failed to provide adequate immunosuppression, necessitating CNI-based therapy in two of three patients for immune-mediated complications. Consistent with prior studies in HLA-matched settings that have not shown superiority of PTCy monotherapy over PTCy plus CNI, GVHD prophylaxis with single-agent PTCy should be carefully considered.

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