Graft-versus-Host Disease Prophylaxis and Immune Reconstitution After Allogeneic Transplantation
DOI:
https://doi.org/10.5281/zenodo.22238007Keywords:
graft-versus-host disease; cyclophosphamide; immune reconstitution; allogeneic transplantation; prophylaxisAbstract
Background: Prophylaxis against graft-versus-host disease has changed more in the past decade than in the preceding three,
and each regimen shapes immune recovery differently.
Objective: To review the randomised evidence for current prophylaxis regimens and what each does to immune
reconstitution.
Methods: Narrative review of randomised trials, registry analyses and reconstitution studies in allogeneic transplantation.
Findings: Post-transplant cyclophosphamide raised one-year graft-versus-host-disease-free relapse-free survival from 34.9%
to 52.7% (hazard ratio 0.64), while overall survival, relapse and transplantation-related death did not differ substantially.
Anti-lymphocyte globulin halved chronic disease with identical survival, and a registry analysis of 5,209 matched-sibling
transplants found the two regimens indistinguishable except in relapse.
Conclusions: The gains are in composite endpoints. Whether they represent better transplantation or better-scored
transplantation is the open question.
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