Comparative study between Post-Transplant Cyclophosphamide vs Methotrexate in HLA-Matched related donor in hematological malignancies as regard Acute Graft Versus Host Disease or CytomegaloVirus reactivation

Abstract

raft-versus-host disease (GVHD) continues to compromise the overall success of allo-geneic hematopoietic cell transplantation (HCT). Although rates and severity of acute GVHD have decreased with improvements in donor selection criteria, pharmacologic prophylaxes, and supportive care, rates of chronic GVHD have remained remarkably stable at 35% to 50%for many years. The median duration of systemic immunosuppressive treatment of chronic GVHD is 2.5 years after bone marrow transplantation (BMT) and 3.5 years after mobilized blood cell transplantation. Because chronic GVHD contributes to long-term morbidity and mortality after allo-HCT, strategies that prevent this complication without compromising beneficial graft-versus-tumor (GVT) effects are urgently needed. Recent studies have convincingly shown that high-dose cyclophosphamide(Cy) given early after HCT does not compromise engraftment and can decrease the risk of chronic GVHD. In conjunction with high-dose pre-transplant conditioning, the immunosuppressive regimen was safe, and effective GVHD-protection did not compromise control of underlying malignancy.