Timing of initiation of calcineurin inhibitors in pediatric haploidentical transplantation with post-transplantation cyclophosphamide: Effects on survival, relapse, and cytokine release syndrome

Uygun, VedatKarasu, GülsümYalçın, KorayÖztürkmen, SedaDaloğlu, HayriyeÇelen, Safiye SunaHazar, VolkanYeşilipek, Akif2022-07-252022-07-252022Uygun V, Karasu G, Yalçın K, Öztürkmen S, Daloğlu H, Çelen SS, Hazar V, Yeşilipek A. Timing of Initiation of Calcineurin Inhibitors in Pediatric Haploidentical Transplantation with Post-Transplantation Cyclophosphamide: Effects on Survival, Relapse, and Cytokine Release Syndrome. Acta Haematol. 2022;145(4):362-370. doi: 10.1159/000521211. Epub 2021 Nov 30. PMID: 34847551.0001-5792http://doi.org/10.1159/000521211https://hdl.handle.net/20.500.12713/3044Background: The use of unmanipulated haploidentical hematopoietic stem cell transplantations (haplo-HSCT) with post-transplant cyclophosphamide (PTCY) in children has emerged as an acceptable alternative to the patients without a matched donor. However, the timing of calcineurin inhibitors (CNIs) used in combination with PTCY is increasingly becoming a topic of controversy. Method: We evaluated 49 children with acute leukemia who underwent unmanipulated haplo-HSCT with PTCY according to the initiation day of CNIs (pre- or post-cyclophosphamide [CY]). Results: There were no significant differences in the overall survival analysis between the 2 groups. The cumulative incidence of relapse at 2 years was 21.2% in the pre-CY group and 38.9% in the post-CY group (p = 0.33). Cytokine release syndrome (CRS) was observed more frequently in the post-CY group (p = 0.04). The overall survival and event-free survival at 2 years in patients with and without CRS in the pre-CY group were 42.9% versus 87.5% (p = 0.04) and 38.1% versus 87.5% (p = 0.04), respectively. Conclusion: Our study shows that the argument for starting CNI administration after CY is tenuous, and the rationale for not starting CNIs before CY needs to be reconsidered.eninfo:eu-repo/semantics/closedAccessAcute LeukemiaCalcineurin InhibitorsChildrenCyclophosphamideCytokine Release SyndromeHaploidenticalTiming of initiation of calcineurin inhibitors in pediatric haploidentical transplantation with post-transplantation cyclophosphamide: Effects on survival, relapse, and cytokine release syndromeArticle145436237034847551WOS:0009064586000032-s2.0-85123510630Q310.1159/000521211Q2