BRIEF RESEARCH REPORT article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1610391
This article is part of the Research TopicPTCY and Allo-HCT: A Deep Dive into Outcomes, Toxicities, and Patient-Centered CareView all articles
Post-transplant cyclophosphamide in haploidentical stem cell transplantation: unveiling the impact of transplant conditioning intensity
Provisionally accepted
Umberto Pizzano1
Simona Piemontese2Gabriele Facchin1
Raffaella Greco2Marta Lisa Battista1
Jacopo Peccatori2Renato Fanin1
Fabio Ciceri2
Francesca Patriarca1
Maria Teresa Lupo Stanghellini2*- 1Hematology and Stem Cell Transplantation Uni, University Hospital ASUFC, Udine, Italy
- 2Hematology and Bone Marrow Transplantation Unit, San Raffaele Hospital (IRCCS), Milan, Italy
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The introduction of post-transplant cyclophosphamide (PTCy) is one of the major achievements in the field of haploidentical stem-cell transplantation (haplo-HCT). The Transplant Conditioning Intensity Score (TCI) is a refined classification of conditioning regimens that assigns weight scores to conditioning regimen components. The aim of our analysis was twofold: to assess the effect on transplant outcomes of combining PTCy with calcineurin inhibitor+MMF instead of mTOR inhibitor+MMF for GvHD prophylaxis, and to assess the effect of stratification by TCI in the setting of haplo-HCT. This study was conducted in adult patients who underwent haplo-HCT at the University Hospital of Udine (UUH) or Ospedale San Raffaele (OSR) between Jan-2014 and Dec-2021. Patients received PTCy plus CsA-MMF at UUH and Sirolimus-MMF at OSR. Conditioning intensity was defined by the TCI score. All data were collected prospectively. A total of 216 haplo-HCTs were performed, 81 at UUH and 135 at OSR. Notably, none of the patients at UUH received a high TCI score regimen compared to 72 (53.3%) at OSR. Our results show overlapping survival outcomes (OS, NRM, DFS, GRFS, RI) within the two platforms; we observed a higher incidence of cGvHD within the sirolimus/MMF+PTCy platform; TCI high was found to be the only risk factor for a higher incidence of grade 3-4 aGvHD in univariate analysis. Our results suggest that TCI may reveal the role of chemo-radiotherapy in promoting conditions that may contribute to the occurrence of GvHD. The impact of moderate/severe cGvHD on quality-of-life must challenge our efforts to further optimise prophylactic strategies.
Keywords: Haplo identical hematopoietic stem cell transplantation, PTCy-haplo HSCT, Sirolimus, GRFS, transplant conditioning intensity, GvHD
Received: 11 Apr 2025; Accepted: 25 Jul 2025.
Copyright: © 2025 Pizzano, Piemontese, Facchin, Greco, Battista, Peccatori, Fanin, Ciceri, Patriarca and Lupo Stanghellini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maria Teresa Lupo Stanghellini, Hematology and Bone Marrow Transplantation Unit, San Raffaele Hospital (IRCCS), Milan, Italy
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