A multi-center study of 827 hematopoietic cell transplant (HCT) recipients has identified the factors that predict successful post-HCT immune suppression discontinuation (ISD).
Successful ISD was significantly associated with younger age, minimal residual disease, use of ATG in the conditioning regimen, CNI/MTX as graft-versus-host disease (GVHD) prophylaxis, using a bone marrow graft, and early disease risk. Of the 342 patients who stopped immune suppression, 127 (37%) subsequently needed to restart immune suppression to treat GVHD.
The researchers analyzed the study population comprised of Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0201 and 0402 trials, supplemented with long-term follow-up data from the CIBMTR® (Center for International Blood and Marrow Transplant Research®).
Median follow-up time for surviving patients was 79 months (range, 11-124) for BMT CTN 0201, and 61 months (range, 24-97) for BMT CTN 0402. Graft was peripheral blood stem cells (68%) vs. bone marrow (32%). Donors were sibling (36%), matched unrelated (49%), or mismatched unrelated (14%).
During the total follow-up period, 342 (41%) recipients achieved ISD at least once. Median time from HCT to ISD varied according to prior GVHD history with discontinuation at 190 days for no prior GVHD, 276 days with prior acute GVHD, and 871 days for prior chronic GVHD.
The researchers concluded that their results can support risk-adapted immune suppression management by clinicians and can be used to educate patients on ISD rates.
Pidala J, et al. Biol Blood Marrow Transplant