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<p>Post-transplant cyclophosphamide (PTCy) is an established strategy for graft-versus-host disease (GVHD) prophylaxis; however, the optimal dosing and its combination with anti-thymocyte globulin (ATG) remain unclear, particularly in matched sibling and haploidentical transplant settings. We conducted a retrospective, single-centre study including 15 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) between May 2025 and December 2025. All patients received reduced-dose PTCy (25&#xa0;mg/kg on days + 3 and + 4) in combination with rabbit ATG, along with cyclosporine-based immunosuppression and mycophenolate mofetil (in haploidentical transplants). All 15 patients achieved successful primary engraftment. At a median follow-up of 240 days (range: 120–310 days), overall survival and event-free survival were 100%. Neutrophil and platelet engraftment occurred at a median of 13 days (range: 10–18 days) and 12 days (range: 9–17 days), respectively. Grade II acute GVHD was observed in 2 patients (13%), with no cases of grade III–IV acute GVHD. Chronic GVHD occurred in 3 patients (20%) and was uniformly mild. Cytomegalovirus (CMV) reactivation was noted in 47% of patients. No cases of hemorrhagic cystitis, cardiotoxicity, bacterial or fungal infections, graft failure, or non-relapse mortality were observed. Reduced-dose PTCy combined with ATG appears to be a feasible and effective GVHD prophylaxis strategy with a favourable toxicity profile. However, the relatively high incidence of CMV reactivation highlights the need for optimized viral prophylaxis strategies. Larger prospective studies are required to validate these findings.</p>

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Feasibility and Safety of Reduced-Dose Post-Transplant Cyclophosphamide Combined with Rabbit Anti-Thymocyte Globulin for Graft-Versus-Host Disease Prophylaxis: A Single-Center Retrospective Case Series

  • 期刊论文

  • 发表日期：

    2026年6月20日

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  • Narendra Agrawal,
  • Himani Gupta,
  • Tribikram Panda,
  • Vaisshnavi Goel,
  • Swapnil Tripathi

摘要

Post-transplant cyclophosphamide (PTCy) is an established strategy for graft-versus-host disease (GVHD) prophylaxis; however, the optimal dosing and its combination with anti-thymocyte globulin (ATG) remain unclear, particularly in matched sibling and haploidentical transplant settings. We conducted a retrospective, single-centre study including 15 consecutive patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) between May 2025 and December 2025. All patients received reduced-dose PTCy (25 mg/kg on days + 3 and + 4) in combination with rabbit ATG, along with cyclosporine-based immunosuppression and mycophenolate mofetil (in haploidentical transplants). All 15 patients achieved successful primary engraftment. At a median follow-up of 240 days (range: 120–310 days), overall survival and event-free survival were 100%. Neutrophil and platelet engraftment occurred at a median of 13 days (range: 10–18 days) and 12 days (range: 9–17 days), respectively. Grade II acute GVHD was observed in 2 patients (13%), with no cases of grade III–IV acute GVHD. Chronic GVHD occurred in 3 patients (20%) and was uniformly mild. Cytomegalovirus (CMV) reactivation was noted in 47% of patients. No cases of hemorrhagic cystitis, cardiotoxicity, bacterial or fungal infections, graft failure, or non-relapse mortality were observed. Reduced-dose PTCy combined with ATG appears to be a feasible and effective GVHD prophylaxis strategy with a favourable toxicity profile. However, the relatively high incidence of CMV reactivation highlights the need for optimized viral prophylaxis strategies. Larger prospective studies are required to validate these findings.