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Abstract：
Allogeneic hematopoietic cell transplantation (allo-HSCT) stands as an effective treatment method for various hematologic malignancies. However, graft-versus-host disease (GvHD), an intricate immunological phenomenon where donor immune cells target recipient tissues, remains a significant challenge, particularly in mismatched unrelated donors (MMUD). Post-transplant cyclophosphamide (PTCy) has emerged as a promising immunosuppressive strategy, revolutionizing haploidentical transplantation and demonstrating promise in MMUD settings. Background/Objectives: This study aimed to evaluate the impact of PTCy on MMUD allo-HSCT outcomes, specifically its effects on GvHD incidence and overall survival, compared to anthitymocyte globulin (ATG). Methods: One hundred seventy-four patients were classified into three groups based on the type of transplantation: PTCy-haplo (114/174; 65.5%), PTCy-MMUD (23/174; 13.2%), and ATG-MMUD (37/174; 21.2%). Results: Our findings showed that PTCy-MMUD significantly reduced acute GvHD occurrence compared to PTCy-haplo and ATG-MMUD approaches (p = 0.006). The delayed onset of acute GvHD in the PTCy-MMUD group suggests a more controlled immune reconstitution, contributing to the lower incidence. Importantly, PTCy-MMUD exhibited enhanced five-year overall survival rates, aligning with the notion that reduced GvHD correlates with improved patient outcomes (p = 0.032). Conclusions: We believe that this study contributes valuable insights into PTCy-MMUD\'s management, underscoring its potential to significantly reduce GvHD incidence and enhance survival outcomes. Although further investigations and clinical trials are warranted, this research underscores the promising role of PTCy-based GvHD prophylaxis in improving MMUD allo-HCT success.
摘要：
异基因造血细胞移植（allo-HSCT）是各种血液系统恶性肿瘤的有效治疗方法。然而,移植物抗宿主病（GvHD），一种复杂的免疫现象，供体免疫细胞靶向受体组织，仍然是一个重大挑战，特别是在不匹配的无关供体（MMUD）中。移植后环磷酰胺（PTCy）已成为一种有前途的免疫抑制策略，革命性的单倍体移植，并在MMUD设置中证明了希望。背景/目标：本研究旨在评估PTCy对MMUDallo-HSCT结局的影响，特别是它对GvHD发病率和总生存率的影响，与人体细胞球蛋白(ATG)相比。方法：根据移植类型将174例患者分为三组：PTCy-haplo（114/174；65.5％），PTCy-MMUD（23/174；13.2%），和ATG-MMUD（37/174；21.2%）。结果：我们的发现表明，与PTCy-haplo和ATG-MMUD方法相比，PTCy-MMUD显着减少了急性GvHD的发生（p=0.006）。PTCy-MMUD组中急性GvHD的延迟发作表明免疫重建更加受控，有助于降低发病率。重要的是,PTCy-MMUD提高了5年总生存率，与GvHD降低与患者预后改善相关的观点一致(p=0.032).结论：我们相信这项研究为PTCy-MMUD的管理提供了有价值的见解，强调其显着降低GvHD发病率和提高生存结果的潜力。尽管需要进一步的调查和临床试验，这项研究强调了基于PTCy的GvHD预防在改善MMUDallo-HCT成功中的有希望的作用.
