What question did this study set out to answer?

The study aims to evaluate the effects of reduced-dose post-transplant cyclophosphamide and low-dose ATG on transplant outcomes for AML.

March 1, 2026

Improved early transplant outcomes with reduced-dose PTCy and low-dose ATG in matched unrelated donor allogeneic transplantation for acute myeloid leukaemia.

Puntos clave

The study aims to evaluate the effects of reduced-dose post-transplant cyclophosphamide and low-dose ATG on transplant outcomes for AML.
Prospective pilot study initiated in July 2024
Evaluated 41 patients receiving reduced-dose PTCy (35 mg/kg) and low-dose ATG (2 mg/kg)
Outcomes compared to a cohort receiving standard-dose PTCy (100 mg/kg) with the same ATG dosage
Follow-up included monitoring complications and survival rates
Faster platelet engraftment with PTCy70 (13 days vs. 16 days, p < 0.001)
Lower risk of bloodstream infections with PTCy70 (HR 0.39)
No difference in grade II-IV acute graft-versus-host disease or non-relapse mortality between groups
Fewer cardiac events observed in the PTCy70 group (5% vs. 17%, p = 0.06)
Twelve-month relapse and overall survival rates were similar between the two groups

Resumen

Post-transplant cyclophosphamide (PTCy) is associated with infectious and organ toxicities. Dose optimization may reduce these risks while maintaining efficacy. We initiated a prospective pilot study in July 2024 evaluating reduced-dose PTCy (35 mg/kg on days +3 and +4; PTCy70) with low-dose anti-thymocyte globulin (ATG) (2 mg/kg) in adults with acute myeloid leukaemia (AML) undergoing matched unrelated donor (MUD) transplantation. Outcomes were compared with a contemporary cohort receiving PTCy100 with ATG 2 mg/kg. Of 173 patients, 41 received PTCy70. Platelet engraftment was faster with PTCy70, 13 vs. 16 days (p < 0.001). In multivariable analysis, PTCy70 was associated with lower risk of bloodstream infections (hazard ratio HR 0.39, 95% confidence interval CI, 0.19-0.78, p = 0.007). At day+100, the incidence of grade II-IV (30.4% vs. 20.3%, p = 0.17), grade III-IV acute graft-versus-host disease (GVHD) (3% vs. 3%, p = 0.08) and non-relapse mortality (3.8% vs. 2.8%, p = 0.67) were similar between groups. Cardiac events were less frequent with PTCy70 (5% vs. 17%; p = 0.06). No cases of sinusoidal obstruction syndrome were observed in the PTCy70 group. At 12 months, relapse (11.1% vs. 15.3%, p = 0.88) and overall survival (79.6% vs. 83.2%, p = 0.87) did not differ between groups. PTCy70 was associated with faster platelet engraftment, fewer bloodstream infections and cardiac events without compromising GVHD, relapse or survival, supporting evaluation in randomized trials.

Me gusta

Guardar