GVHD
Published on December 24, 2024
Association of GVHD and GVL in AML patients after SCT with calcineurin- or PTCy-based prophylaxis
by Nature
Shimoni A, Peczynski C, Labopin M, et al. Post-Transplant Cyclophosphamide Separates Graft-Versus Host Disease and Graft Versus Leukemia Effects After HLA-Matched Stem-Cell Transplantation for Acute Myeloid Leukemia. Leukemia. 2024; (doi: 10.1038/s41375-024-02445-x).
As the stem cell transplantation (SCT) landscape has evolved, scientists say the balance between graft-versus-leukemia (GVL) and graft-versus-host disease (GVHD) effects has also shifted. The early years of SCT established that acute and chronic GVHD reduced the risk of relapse post-transplant; that mild cases were associated with better survival and severe cases with higher non-relapse mortality (NRM); and that chronic GVHD was key to controlling relapse in patients with acute myeloid leukemia (AML). With the introduction of post-transplant cyclophosphamide (PTCy), researchers suspect the association between GVHD and GVL is now void. A retrospective study examined the immune effects in adults with AML who underwent HLA-matched SCT with standard calcineurin-based GVHD prophylaxis (n=12,653) and a second cohort of patients who received PTCy (n=508). Acute and extensive chronic GVHD were associated with lower relapse, higher NRM, and lower overall survival (OS) in the calcineurin group. In the PTCy group, acute GVHD also predicted higher NRM and lower OS but not relapse; and chronic GVHD was not prognostic for any of the targeted outcomes. The findings suggest GVHD — regardless of type or grade — does not mediate lower relapse rates after HLA-matched SCT with PTCY and likely conveys zero survival benefit in this setting.
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