CAST regimen for acute GVHD prophylaxis after HSCT

Al-Homsi AS, Cirrone F, Wo S, et al. PTCy, Abatacept, and Short Course of Tacrolimus for GVHD Prevention Following Haploidentical Transplantation. Blood Advances. 2023; (doi: 10.1182/bloodadvances.2023010545).

A Phase Ib-II clinical trial found that a regimen of combined post-transplant cyclophosphamide (PTCy), abatacept, and short-course tacrolimus (CAST) reduced the rate of grades II-IV acute graft-versus host disease (GVHD) safely and effectively following haploidentical hematopoietic stem cell transplantation. The study included 46 patients, median age 60 years. At day +120, the cumulative incidence of acute GVHD grades II-IV — the primary endpoint — was 17.4%, while the incidence of grades III-IV acute GVHD was 4.4%. The cumulative incidence of 1-year treatment-related mortality at a median 15.3-month follow-up was 4.4%. Estimated rates for 1-year chronic GVHD moderate to severe and relapse were 15.9% and 11.7%, respectively, with rates of progression-free survival, overall survival, and GVHD- and relapse-free survival at that point totaling 84.1%, 85.9%, and 66.1%, respectively. Patients had toxicities at rates comparable to those expected in individuals undergoing haploidentical transplantation.

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Tags: GVHD, acute, Acute GVHD, aGVHD, PTCy, graft, graft-versus-host disease, graft-vs-host disease, graft-versus-host