|The following article features coverage from the 2021 Annual Meeting of the Society of Hematologic Oncology (SOHO). Click here to read more of Hematology Advisor‘s conference coverage.|
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).
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.”
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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.