GVHD Prevention and Enhanced Outcomes in Stem Cell Transplants

Roswell Park Comprehensive Cancer Center is implementing three strategies to improve the success and safety of allogeneic stem cell transplant. First, the use of post-transplant cyclophosphamide (PTCy) graft versus host disease prophylaxis is being employed for all donor sources. This strategy has significantly reduced the rates of acute and chronic graft versus host disease, as well as the need for systemic immune suppression. Second, the prioritization of younger donors, particularly those under the age of 40, has been shown to improve transplant outcomes. Even with partial human leukocyte antigen (HLA) matches, the use of PTCy allows for successful transplants. Lastly, efforts are being made to minimize the duration of immune suppression, aiming to start tapering immune suppression within two to three months post-transplant.

The use of PTCy-based GVHD prophylaxis has decreased the likelihood of life-threatening acute GVHD from 25% to less than 10%. The risk of chronic GVHD, which generally requires systemic immune suppression, has also declined from 40-60% to 5-10%. These improvements not only enhance patients’ quality of life but also reduce the risk of side effects like infections, diabetes, and bone problems. Additionally, focusing on younger donors and using PTCy allow for successful transplants even with partial HLA matches. This expands the pool of potential donors and improves health equity. Lastly, minimizing the duration of immune suppression not only decreases the burden of infections but also enables a smoother transition to post-transplant maintenance therapy, reducing the risk of relapse. The aim is for transplant patients to be cured of their malignancy and well by their two-year post-transplant anniversary.

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