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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Biol+Blood+Marrow+Transplant
2020 ; 26
(7
): 1312-1317
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Graft Cryopreservation Does Not Impact Overall Survival after Allogeneic
Hematopoietic Cell Transplantation Using Post-Transplantation Cyclophosphamide
for Graft-versus-Host Disease Prophylaxis
#MMPMID32283185
Hamadani M
; Zhang MJ
; Tang XY
; Fei M
; Brunstein C
; Chhabra S
; D'Souza A
; Milano F
; Phelan R
; Saber W
; Shaw BE
; Weisdorf D
; Devine SM
; Horowitz MM
Biol Blood Marrow Transplant
2020[Jul]; 26
(7
): 1312-1317
PMID32283185
show ga
The COVID-19 pandemic has created significant barriers to timely donor
evaluation, cell collection, and graft transport for allogeneic hematopoietic
stem cell transplantation (allo-HCT). To ensure availability of donor cells on
the scheduled date of infusion, many sites now collect cryopreserved grafts
before the start of pretransplantation conditioning. Post-transplantation
cyclophosphamide (ptCY) is an increasingly used approach for graft-versus-host
disease (GVHD) prophylaxis, but the impact of graft cryopreservation on the
outcomes of allo-HCT using ptCY is not known. Using the Center for International
Blood and Marrow Transplant Research (CIBMTR) database, we compared the outcomes
of HCT using cryopreserved versus fresh grafts in patients undergoing HCT for
hematologic malignancy with ptCY. We analyzed 274 patients with hematologic
malignancy undergoing allo-HCT between 2013 and 2018 with cryopreserved grafts
and ptCY. Eighteen patients received bone marrow grafts and 256 received
peripheral blood stem cell grafts. These patients were matched for age, graft
type, disease risk index (DRI), and propensity score with 1080 patients who
underwent allo-HCT with fresh grafts. The propensity score, which is an
assessment of the likelihood of receiving a fresh graft versus a cryopreserved
graft, was calculated using logistic regression to account for the following:
disease histology, Karnofsky Performance Score (KPS), HCT Comorbidity Index,
conditioning regimen intensity, donor type, and recipient race. The primary
endpoint was overall survival (OS). Secondary endpoints included acute and
chronic graft-versus-host disease (GVHD), non-relapse mortality (NRM),
relapse/progression and disease-free survival (DFS). Because of multiple
comparisons, only P values <.01 were considered statistically significant. The 2
cohorts (cryopreserved and fresh) were similar in terms of patient age, KPS,
diagnosis, DRI, HCT-CI, donor/graft source, and conditioning intensity. One-year
probabilities of OS were 71.1% (95% confidence interval [CI], 68.3% to 73.8%)
with fresh grafts and 70.3% (95% CI, 64.6% to 75.7%) with cryopreserved grafts
(P = .81). Corresponding probabilities of OS at 2 years were 60.6% (95% CI, 57.3%
to 63.8%) and 58.7% (95% CI, 51.9% to 65.4%) (P = .62). In matched-pair
regression analysis, graft cryopreservation was not associated with a
significantly higher risk of mortality (hazard ratio [HR] for cryopreserved
versus fresh, 1.05; 95% CI, .86 to 1.29; P = .60). Similarly, rates of neutrophil
recovery (HR, .91; 95% CI, .80 to 1.02; P = .12), platelet recovery (HR, .88; 95%
CI, .78 to 1.00; P = .05), grade III-IV acute GVHD (HR, .78; 95% CI, .50 to 1.22;
P = .27), NRM (HR, 1.16; 95% CI, .86 to 1.55; P = .32) and relapse/progression
(HR, 1.21; 95% CI, .97 to 1.50; P = .09) were similar with cryopreserved grafts
versus fresh grafts. There were somewhat lower rates of chronic GVHD (HR, 78; 95%
CI, .61 to .99; P = .04) and DFS (HR for treatment failure, 1.19; 95% CI, 1.01 to
1.29; P = .04) with graft cryopreservation that were of marginal statistical
significance after adjusting for multiple comparisons. Overall, our data indicate
that graft cryopreservation does not significantly delay hematopoietic recovery,
increase the risk of acute GVHD or NRM, or decrease OS after allo-HCT using ptCY.
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Bone Marrow Transplantation/*methods
[MESH]
|COVID-19
[MESH]
|Cohort Studies
[MESH]
|Coronavirus Infections/*epidemiology
[MESH]
|Cryopreservation/*methods
[MESH]
|Cyclophosphamide/therapeutic use
[MESH]
|Female
[MESH]
|Graft vs Host Disease/immunology/mortality/pathology/*prevention & control
[MESH]