Early Tapering of Cyclosporine Is Feasible in Haploidentical Stem Cell Transplantation: A Single Center Experience

• Published in: Clinical transplantation Vol. 38; no. 6; pp. e15376 - n/a
• Main Authors: Yaman, Samet, Başci, Semih, Bozan, Ersin, Seçilmiş, Sema, Candir, Burcu Aslan, Yiğenoğlu, Tuğçe Nur, Çakar, Merih Kızıl, Dal, Mehmet Sinan, Altuntaş, Fevzi
• Format: Journal Article
• Language: English
• Published: Denmark 01.06.2024
• Subjects: Adult; cyclosporine; Cyclosporine - administration & dosage; Cyclosporine - therapeutic use; Female; Follow-Up Studies; Graft Survival - drug effects; Graft vs Host Disease - etiology; Graft vs Host Disease - prevention & control; GVHD; haploidentical stem cell transplantation; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Transplantation Conditioning - methods; Transplantation, Haploidentical - methods; Young Adult; cyclosporine; haploidentical stem cell transplantation; GVHD
• DOI: 10.1111/ctr.15376
• ISSN: 0902-0063; 1399-0012

ABSTRACT Introduction Cyclosporine‐A (CsA) and post transplantation cyclophosphamide (PTCy) are common agents used for graft versus host disease (GVHD) prophylaxis in Haploidentical hematopoietic cell transplantation (haplo‐HCT). However, the impact of CsA cessation timing in the posttransplant setting on clinical outcomes is uncertain. We aimed to investigate the impact of a novel approach that integrated early CsA cessation with PTCy utilization. Patients and Methods This study was a single arm retrospective study carried out at a tertiary referral hospital hematology and bone marrow transplantation center between 2009 and 2022. The patients who received haplo‐HCT with ATG, PTCy and CsA as GVHD prophylaxis were included. CsA was planned for cessation starting at day 45 to day 60. Acute and chronic GVHD were evaluated and graded. CsA blood concentrations and its impact on acute and chronic GVHD was evaluated. Results Thirty‐one patients composed of 19 (61.3%) male and 12 (38.7%) female patients with a median age of 31 years (20–58). Busulfan and TBI based conditioning regimens were the most utilized regimens. The majority of donors were first degree relatives. Stem cell origin was peripheral blood for all patients. GVHD prophylaxis consisted of ATG, CsA and PTCy. Acute GVHD was observed in 9 (29%) cases, whereas chronic GVHD was seen in 3 (9.7%) cases, with 2 of them having overlapping GVHD. Age, gender, number of chemotherapy lines, transplant characteristics, infused CD34 cell count, and engraftment durations were similar among patients with and without GVHD. Patients with GVHD had similar 1st, 2nd, 3rd and 4th week CsA concentrations compared to patients without GVHD (p > 0.05). The presence of GVHD was not associated with worse progression free survival and overall survival (p = 0.6, p = 0.5, respectively). CMV reactivation was more common in the GVHD group. Conclusion In the current study, we did not find an impact of CsA concentration on GVHD and post‐transplant outcomes in Haplo‐HCT setting. Therefore, together with the use of PTCy, early CsA cessation can be an option; further studies are needed to understand all aspects of this approach.