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Impact of cyclosporine A concentration on acute graft‐vs‐host disease incidence after haploidentical hematopoietic cell transplantation
Author(s) -
Stocker Nicolas,
Duléry Remy,
Battipaglia Giorgia,
Brissot Eolia,
Médiavilla Clémence,
Sestili Simona,
Paviglianiti Annalisa,
Ledraa Tounes,
Mohty Razan,
Bazarbachi Abdulhamid,
Belhocine Ramdane,
Vekhoff Anne,
Ruggeri Annalisa,
Mohty Mohamad,
Malard Florent
Publication year - 2019
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13233
Subject(s) - medicine , cumulative incidence , gastroenterology , cyclophosphamide , incidence (geometry) , transplantation , graft versus host disease , hematopoietic stem cell transplantation , hematopoietic cell , retrospective cohort study , immunology , surgery , haematopoiesis , chemotherapy , stem cell , biology , physics , optics , genetics
Objectives This retrospective study analyzed the impact of early cyclosporine A (CsA) initiation (day −3) on the risk of acute graft‐vs‐host disease (aGvHD) after haploidentical hematopoietic cell transplantation (Haplo‐HCT) using post‐transplant cyclophosphamide. Methods Sixty‐one consecutives patients who underwent Haplo‐HCT were analyzed. Results At day +180, the cumulative incidences of grade II‐IV and grade III‐IV aGvHD were 39% and 18%, respectively. Patients having a lowest CsA concentration (<301 ng/mL; the cutoff value used to segregate the patients between low and high CsA concentrations) in the first week after Haplo‐HCT had a significantly higher risk of grade II‐IV aGvHD ( P = 0.02), severe grade III‐IV aGvHD ( P = 0.03), cGvHD ( P = 0.02), and extensive cGvHD ( P = 0.04). In multivariate analysis, a higher CsA concentration (≥301 ng/mL) during the first week following Haplo‐HCT was the only parameter significantly associated with a reduced risk of grade II‐IV and grade III‐IV aGvHD (RR = 0.21; P = 0.049 and RR < 0.001; P < 0.0001, respectively). We find no correlation between CsA concentration and relapse, non‐relapse mortality, progression‐free survival, GvHD‐free and progression‐free survival, or overall survival. Conclusions CsA could be initiated early before Haplo‐HCT with achievement of high CsA concentration to reduce the risk of aGvHD without any detrimental effect on relapse.