Publication Type : Journal Article
Publisher : Biology of Blood and Marrow Transplantation
Source : Biology of Blood and Marrow Transplantation, Volume 26, Issue 3, Supplement, 2020, Page S279, https://doi.org/10.1016/j.bbmt.2019.12.545
Url : https://www.sciencedirect.com/science/article/pii/S1083879119314740
Campus : Faridabad
School : School of Medicine
Department : General Medicine
Year : 2020
Abstract : Introduction T cell replete Haploidentical transplants have usually employed Tacrolimus and Mycophenolate Moefetil as the GVHD prophylaxis with Post-transplant cyclophosphamide(PTCy). Cyclosporine A(CsA) has been successfully utilized earlier in place of Tacrolimus with this strategy. Injectable tacrolimus is not available in India so we considered replacing it with injectable Cyclosporine A. In this retrospective analysis we describe our initial experience with the above strategy. Objectives To assess the feasibility of using intravenous Cyclosporine A with PBSC and PTCy in T-cell replete transplantation for hematological malignancies. Methods From April 2017 to July 2019, 13 patients underwent 14 such transplants, median age 30 years (1-56) for various hematological malignancies AML-6, ALL-3, MPAL-1,CML-BC-4. 3 transplants were done in CR1, 4 in active disease and 7 in CR2. Conditioning used was Flu-Bu in 5 patients, Flu-Cy-TBI in 5 patients, Clofarabine(Clo)-Bu in 1 patient, Clo-Mel-TBI in 2 patients and Bu-Mel in 1 patient. Intravenous CsA and MMF were started 24 hours after PTCy. CsA trough levels were monitored thrice weekly to target level of 200-300 µg/L. Results All patients except one successfully engrafted at a median of 15.5 days (13-25). At a median follow up of 8 months (2-28 months) the relapse-free suvival was 65.4% while the overall survival was 68%. There were 4 relapses in 3 patients. 2 relapses occurred in patients transplanted in active disease (AML). Grade 1-2 acute GVHD occurred in 28% while grade 1-2 chronic GVHD occurred in 21.4% patients. No patient developed grade 3 or 4 GVHD. There were no treatment related deaths. Conclusion CsA is a feasible option in place of Tacrolimus in T cell replete haploidentical transplantation for hematological malignancies and has an acceptable outcome.
Cite this Research Publication : Prashant Mehta, Rahul Arora, Swati Pabbi. "Feasibility of Cyclosporine a Instead of Tacrolimus after Haploidentical Transplantation Using PBSC Grafts with Post-Transplant Cyclophosphamide for Hematological Malignancies," Biology of Blood and Marrow Transplantation, Volume 26, Issue 3, Supplement, 2020, Page S279, https://doi.org/10.1016/j.bbmt.2019.12.545