Graft Vs Host Prophylaxis With Posttransplant Cyclophosphamide Not Associated With Increased Infection Risk

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According to the results of a study presented at the Annual Meeting of the Society of Hematologic Oncology (SOHO), graft vs host disease (GVHD) prophylaxis with posttransplant cyclophosphamide (PTCy) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) does not appear to be associated with an increased risk in bacterial, viral, or fungal infections.

The investigators sought to characterize the incidence of pre-vaccination infections, including cytomegalovirus (CMV), herpes virus and BK-polyomavirus hemorrhagic cystitis, infection-related mortality, and predictive factors associated with GVHD PTCy prophylaxis in patients who underwent allo-HSCT from 9/10 to 10/10 HLA tissue-matched, unrelated donors. The study took place at 3 centers between 2015 and 2020. Infections that developed within the first 100 days following transplantation were recorded, and patient records were reviewed retrospectively.

The study included 41 patients (61% male), with a mean age was 40.8 years (range, 21-67 years). Most patients (56%; n=23) had a diagnosis of acute myeloid leukemia, followed by acute lymphoblastic leukemia (26%; n=11), non-Hodgkin lymphoma (7%; n=3), myelodysplastic syndrome (5%; n=2), biphenotypic leukemia (2%; n=1), and Hodgkin lymphoma (2%; n=1).


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All patients received a myeloablative priming regimen and empiric administration of levofloxacin, valacyclovir, fluconazole, and trimethoprim-sulfamethoxazole prior to transplantation and PTCy at 72 and 96 hours in combination with calcineurin inhibitors ± methotrexate ± mycophenolate mofetil after transplantation.

During transplantation, all patients experienced at least 1 episode of febrile neutropenia (1 attack in 78% and ≥2 attacks in 22%). Following transplantation (day 9), 1 patient died of septic shock.

Prior to transplantation, nearly all patients (except 1) tested positive for CMV immunoglobulin G (IgG). The incidence of CMV infection requiring treatment was 36.6% within the first 100 days following transplantation and 41.5% at 1 year. Among patients who were CMV IgG-positive, CMV reactivation was observed in 50% (15/30) of those whose donor was also CMV-positive and in 30% (3/10) of those whose donor was CMV-negative. Antiviral therapy was administered to 1 patient who experienced multiple CMV reactivations. CMV pneumonia developed in 4 patient, 3 of whom died.

Following transplantation, the rate of BK-polyomavirus hemorrhagic cystitis was 7.3% (3/41). Within the first year following transplantation, 9.8% of patients (4/41) developed invasive fungal infection, and 2.4% of patients (1/41) had herpes virus infection. Tenofovir-entecavir treatment was administered to 3 patients after anti-HBc positivity; however, HBV reactivation was not detected in any patients.

The investigators concluded, “GVHD prophylaxis containing PTCy after allo-HSCT from an unrelated donor does not have an increased risk in terms of bacterial, viral or fungal infection and can be used safely.”

Read more of Cancer Therapy Advisor’s coverage of SOHO 2021 by visiting the conference page.

Reference

Sayın S, Yıldırım M, Cömert M, et al. Administration of cyclophosphamide for GVHD prophylaxis after stem cell transplantation from unrelated donors and infections: A multi-center experience. Paper presented at: Annual Meeting of the Society of Hematologic Oncology (SOHO); September 8-11, 2021. Abstract AML-184.

This article originally appeared on Hematology Advisor



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