Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity
BackgroundThe introduction of posttransplant cyclophosphamide (PTCy) is one of the major achievements in the field of haploidentical stem cell transplantation (haplo-HCT). The transplant conditioning intensity (TCI) score is a refined classification of conditioning regimens that assigns weight score...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610391/full |
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| author | Umberto Pizzano Umberto Pizzano Umberto Pizzano Simona Piemontese Gabriele Facchin Raffaella Greco Marta Lisa Battista Jacopo Peccatori Renato Fanin Renato Fanin Fabio Ciceri Fabio Ciceri Francesca Patriarca Francesca Patriarca Maria Teresa Lupo-Stanghellini |
| author_facet | Umberto Pizzano Umberto Pizzano Umberto Pizzano Simona Piemontese Gabriele Facchin Raffaella Greco Marta Lisa Battista Jacopo Peccatori Renato Fanin Renato Fanin Fabio Ciceri Fabio Ciceri Francesca Patriarca Francesca Patriarca Maria Teresa Lupo-Stanghellini |
| author_sort | Umberto Pizzano |
| collection | DOAJ |
| description | BackgroundThe introduction of posttransplant cyclophosphamide (PTCy) is one of the major achievements in the field of haploidentical stem cell transplantation (haplo-HCT). The transplant conditioning intensity (TCI) score is a refined classification of conditioning regimens that assigns weight scores to conditioning regimen components. The aim of our analysis was twofold: to assess the effect on transplant outcomes of combining PTCy with calcineurin inhibitor + mycophenolate mofetil (MMF) instead of mTOR inhibitor + MMF for GvHD prophylaxis, and to assess the effect of stratification by conditioning intensity in the setting of haplo-HCT.MethodsThis study was conducted in adult patients who underwent haplo-HCT at the University Hospital of Udine (UUH) or Ospedale San Raffaele (OSR) between January 2014 and December 2021. Patients received PTCy plus CsA-MMF at UUH and sirolimus-MMF at OSR. Conditioning intensity was defined by the TCI score. All data were collected prospectively.ResultsA total of 216 haplo-HCTs were performed, 81 at UUH and 135 at OSR. Notably, none of the patients at UUH received a high TCI score regimen compared to 72 (53.3%) at OSR. Our results show overlapping survival outcomes (OS, NRM, DFS, GRFS, and RI) within the two platforms. We observed a higher incidence of cGvHD within the sirolimus/MMF + PTCy platform, and high TCI was found to be the only risk factor for a higher incidence of grades III–IV aGvHD in univariate analysis.ConclusionOur results suggest that TCI may reveal the role of chemoradiotherapy in promoting conditions that may contribute to the occurrence of GvHD. The impact of moderate/severe cGvHD on quality of life must challenge our efforts to further optimise prophylactic strategies. |
| format | Article |
| id | doaj-art-8a6e4b98751742369ae02ef389dec08f |
| institution | DOAJ |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj-art-8a6e4b98751742369ae02ef389dec08f2025-08-20T03:05:44ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-08-011610.3389/fimmu.2025.16103911610391Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensityUmberto Pizzano0Umberto Pizzano1Umberto Pizzano2Simona Piemontese3Gabriele Facchin4Raffaella Greco5Marta Lisa Battista6Jacopo Peccatori7Renato Fanin8Renato Fanin9Fabio Ciceri10Fabio Ciceri11Francesca Patriarca12Francesca Patriarca13Maria Teresa Lupo-Stanghellini14Haematology and Stem Cell Transplantation Unit, University Hospital ASUFC, Udine, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyHaematology and Bone Marrow Transplantation Unit, Cà Foncello Hospital, Treviso, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyHaematology and Stem Cell Transplantation Unit, University Hospital ASUFC, Udine, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyHaematology and Stem Cell Transplantation Unit, University Hospital ASUFC, Udine, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyHaematology and Stem Cell Transplantation Unit, University Hospital ASUFC, Udine, ItalyDepartment of Medical Area (DAME), University of Udine, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyUniversità Vita-Salute San Raffaele, Milan, ItalyHaematology and Stem Cell Transplantation Unit, University Hospital ASUFC, Udine, ItalyDepartment of Medical Area (DAME), University of Udine, ItalyHaematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, ItalyBackgroundThe introduction of posttransplant cyclophosphamide (PTCy) is one of the major achievements in the field of haploidentical stem cell transplantation (haplo-HCT). The transplant conditioning intensity (TCI) score is a refined classification of conditioning regimens that assigns weight scores to conditioning regimen components. The aim of our analysis was twofold: to assess the effect on transplant outcomes of combining PTCy with calcineurin inhibitor + mycophenolate mofetil (MMF) instead of mTOR inhibitor + MMF for GvHD prophylaxis, and to assess the effect of stratification by conditioning intensity in the setting of haplo-HCT.MethodsThis study was conducted in adult patients who underwent haplo-HCT at the University Hospital of Udine (UUH) or Ospedale San Raffaele (OSR) between January 2014 and December 2021. Patients received PTCy plus CsA-MMF at UUH and sirolimus-MMF at OSR. Conditioning intensity was defined by the TCI score. All data were collected prospectively.ResultsA total of 216 haplo-HCTs were performed, 81 at UUH and 135 at OSR. Notably, none of the patients at UUH received a high TCI score regimen compared to 72 (53.3%) at OSR. Our results show overlapping survival outcomes (OS, NRM, DFS, GRFS, and RI) within the two platforms. We observed a higher incidence of cGvHD within the sirolimus/MMF + PTCy platform, and high TCI was found to be the only risk factor for a higher incidence of grades III–IV aGvHD in univariate analysis.ConclusionOur results suggest that TCI may reveal the role of chemoradiotherapy in promoting conditions that may contribute to the occurrence of GvHD. The impact of moderate/severe cGvHD on quality of life must challenge our efforts to further optimise prophylactic strategies.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610391/fullhaplo identical hematopoietic stem cell transplantationPTCy-haplo HSCTsirolimusGRFStransplant conditioning intensityGvHD |
| spellingShingle | Umberto Pizzano Umberto Pizzano Umberto Pizzano Simona Piemontese Gabriele Facchin Raffaella Greco Marta Lisa Battista Jacopo Peccatori Renato Fanin Renato Fanin Fabio Ciceri Fabio Ciceri Francesca Patriarca Francesca Patriarca Maria Teresa Lupo-Stanghellini Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity Frontiers in Immunology haplo identical hematopoietic stem cell transplantation PTCy-haplo HSCT sirolimus GRFS transplant conditioning intensity GvHD |
| title | Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity |
| title_full | Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity |
| title_fullStr | Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity |
| title_full_unstemmed | Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity |
| title_short | Post-transplant cyclophosphamide in haploidentical stem cell transplantation: evaluating the impact of transplant conditioning intensity |
| title_sort | post transplant cyclophosphamide in haploidentical stem cell transplantation evaluating the impact of transplant conditioning intensity |
| topic | haplo identical hematopoietic stem cell transplantation PTCy-haplo HSCT sirolimus GRFS transplant conditioning intensity GvHD |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1610391/full |
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