Mielcarek M, (2016) Blood, (Link to abstract)
GVHD post HSCT is associated with major morbidity and hampers survival. The authors analyzed in a prospective trial of 43 patients (pediatric n=5) with high-risk hematologic malignancies treated on a novel protocol with myeloablative conditioning regimens (TBI containing with 12Gy radiation, n=18, and non-TBI regimen FluBu, n=25) and post-HSCT high-dose cyclophosphamide (50mg/kg on days 3 and 4 post-HSCT). Additional GVHD prophylaxis consisted of cyclosporine A starting on day +5. Graft source was exclusively peripheral stimulated blood. The authors found a relatively high incidence of acute GVHD grade II of 77% but a low incidence of grade III-I
* acute GVHD of 0% and an incidence of chronic GVHD needing systemic immunosuppression of 16%. Non-relapse mortality after 2 years was 14%, relapse-mortality was 17%. TBI was associated with lower relapse incidence but higher cGVHD, whereas BuFlu was associated with lower incidence of cGVHD and lower overall survival (with the two groups being distinct in terms of their age and recurrence risks).
* Post-HSCT high-dose cyclophosphamide was tolerated post myeloablative conditioning regimens and led to a relatively low incidence of cGVHD needing systemic immunosuppression in a mixed adult/ pediatric population.